{ "hospital_name": "Mercy Medical Center", "last_updated_on": "2026-09-01", "version": "3.0", "location_name": [ "Mercy Medical Center" ], "hospital_address": [ "1325 N. Highland, Aurora, Illinois 60506" ], "license_information": { "license_number": "0006446", "state": "IL" }, "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Fernando Gruta" }, "type_2_npi": [ "1598503922", "1548079304" ], "standard_charge_information": [ { "description": "*COXSACKIE A, 10 ANTIBODY", "code_information": [ { "code": "86658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.0, "discounted_cash": 13.0, "minimum": 7.818, "maximum": 52.0, "payers_information": [ { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 47.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 30.44 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 47.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 47.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 46.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "*ALBUMIN FOR TESTOSTERONE", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.0, "discounted_cash": 4.0, "minimum": 2.97, "maximum": 144.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.43 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 48.96, "10th_percentile": 48.96, "90th_percentile": 48.96, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.52 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.97, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.62 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.62 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.18 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.62 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "*ALPHA FETOPROTEIN MATERNAL", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268.0, "discounted_cash": 16.0, "minimum": 10.062, "maximum": 268.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.47 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 18.76 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.97 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.06, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.32 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "*COCCIDIODES ANTIBODY", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.0, "discounted_cash": 11.0, "minimum": 6.882, "maximum": 74.0, "payers_information": [ { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.67 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 26.79 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.27 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.63 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 } ] } ] }, { "description": "*URINE CREATININE RANDOM", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 190.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "*BRUCELLA ABORTUS AB", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 6.0, "minimum": 4.188, "maximum": 51.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 9.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.6 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 7.72 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.43 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "*COXSACKIE A, 16 ANTIBODY", "code_information": [ { "code": "86658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.0, "discounted_cash": 13.0, "minimum": 7.818, "maximum": 52.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 30.44 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 47.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 47.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 46.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 47.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "*TESTOSTERONE TOTAL", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 605.0, "discounted_cash": 25.0, "minimum": 13.44, "maximum": 605.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 34.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 36.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.81, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 29.05 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 59.66 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 159.87 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 159.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 156.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.42 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.97, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 159.87 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "14-3-3 PROTEIN, CSF - 0035U - 30190070", "code_information": [ { "code": "0035U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1963.0, "discounted_cash": 540.0, "minimum": 324.594, "maximum": 1963.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 649.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 595.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 568.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 365.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 513.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 365.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 730.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 757.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 876.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.25 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1963.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.59, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 838.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 622.14, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.25 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 365.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 595.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 784.44 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 568.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.25 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 568.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 811.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 557.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 557.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 568.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 365.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 649.19, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 676.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 557.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "*PROTEUS OXIA AB", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 6.0, "minimum": 4.188, "maximum": 51.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 9.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.6 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 7.72 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.43 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "*CRYPTOSPROIDIUM EIA", "code_information": [ { "code": "87328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.0, "discounted_cash": 13.0, "minimum": 8.292, "maximum": 197.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.21 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 15.45 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.68 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 84.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.04 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 14.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.58, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.23, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "17 HYDROXPROGESTERONE", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.0, "discounted_cash": 27.0, "minimum": 13.44, "maximum": 267.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 36.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.06 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 62.71 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 132.03 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 132.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.25, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 129.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 29.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.4 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.6, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 132.03 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "14-3-3 PROTEIN, CSF - 83520 - 30190075", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 17.0, "minimum": 10.362, "maximum": 328.0, "payers_information": [ { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 157.8 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.19 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 19.49 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 157.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 157.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 154.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.04 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "3D RENDERING AT IND WKST-MRI", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1513.0, "minimum": 43.38, "maximum": 1513.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1513.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1200.0 }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1513.0 }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.38 } ] } ] }, { "description": "17 HYDROXYPREGNENOLONE, LC/MS", "code_information": [ { "code": "84143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 22.0, "minimum": 13.44, "maximum": 102.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.95, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.35 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 25.74 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 52.97 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.07 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 23.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 23.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "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": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "17-KETOSTEROIDS", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.0, "discounted_cash": 12.0, "minimum": 7.68, "maximum": 73.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.74, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "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": 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.36, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "3D RENDERING NO IND WKST-MRI", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1095.0, "minimum": 16.71, "maximum": 1337.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1095.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1095.0 }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1095.0 }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.71 } ] } ] }, { "description": "17-OH CORTICOSTEROIDS", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "discounted_cash": 17.0, "minimum": 10.74, "maximum": 177.0, "payers_information": [ { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.96 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.92 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 20.23 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 40.79 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 } ] } ] }, { "description": "3D CARDIAC MAPPING", "code_information": [ { "code": "93613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7313.0, "minimum": 232.0, "maximum": 7313.0, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7313.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7313.0 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7313.0 }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7313.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7313.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7313.0 }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7313.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7313.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 281.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 281.23 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 7313.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7313.0 } ] } ] }, { "description": "3D RECONSTRUCTION", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1259.0, "minimum": 16.71, "maximum": 1337.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1259.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1200.0 }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1259.0 }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.71 } ] } ] }, { "description": "5NUCLEOTIDASE", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.0, "discounted_cash": 11.0, "minimum": 6.69, "maximum": 181.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.31 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.57 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.17 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.48, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "5-A-DIHYDROTESTOSTERONE", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.0, "discounted_cash": 24.0, "minimum": 12.17, "maximum": 264.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 32.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 33.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.8 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 27.22 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 42.02 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.7, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.93 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.91, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "A. GALACTOMANNAN AG-BRONCH", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.0, "discounted_cash": 11.0, "minimum": 7.188, "maximum": 81.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.41, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "A. FUMIGATUS #1 AB", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.0, "discounted_cash": 15.0, "minimum": 9.03, "maximum": 214.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.66 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.7 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "5-HIAA, 24 HR", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.0, "discounted_cash": 12.0, "minimum": 7.74, "maximum": 304.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.9, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 150.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 150.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.71 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "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": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 150.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AB DRAIN, PELVIC", "code_information": [ { "code": "45020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4363.0, "discounted_cash": 2959.0, "minimum": 488.0, "maximum": 4363.0, "payers_information": [ { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4363.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2966.17 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4363.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4363.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 3734.87 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 3734.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3403.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3137.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2966.17 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 3656.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2824.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3255.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2966.17 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4363.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2966.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 601.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 601.66 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2823.27 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2824.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4363.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3699.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 3734.87 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3551.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3255.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2824.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2811.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2824.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3995.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4143.82, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "A. FUMIGATUS #6 AB", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.0, "discounted_cash": 15.0, "minimum": 9.03, "maximum": 214.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.66 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.7 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "A V ABLATION", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14873.0, "discounted_cash": 8317.0, "minimum": 232.0, "maximum": 14873.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9980.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9149.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14873.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8733.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14873.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7901.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14873.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 11228.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11644.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13474.03, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14873.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12891.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9564.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8816.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14873.0 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14873.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9149.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8733.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14873.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8733.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12475.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8566.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14873.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8566.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8733.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 562.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 562.23 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 14873.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14873.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14873.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10396.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8566.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "A. FUMIGATUS #2 AB", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.0, "discounted_cash": 15.0, "minimum": 9.03, "maximum": 214.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.66 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.7 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN WO CONTRAST", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3991.0, "discounted_cash": 111.0, "minimum": 83.95, "maximum": 3991.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 133.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 105.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 156.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 180.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.71 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1460.0 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1446.02 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1446.02 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.71 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1415.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 824.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.71 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.71 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.95 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 133.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.48, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1446.02 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN PORTABLE 1 VIEW", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 852.0, "discounted_cash": 92.0, "minimum": 21.86, "maximum": 852.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 88.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 129.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.19 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 289.68, "10th_percentile": 289.68, "90th_percentile": 289.68, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 24.26 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 255.6, "10th_percentile": 255.6, "90th_percentile": 255.6, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.16, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 115.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "A. FLAVUS AB", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.0, "discounted_cash": 15.0, "minimum": 9.03, "maximum": 214.0, "payers_information": [ { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.7 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.66 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.92 } ] } ] }, { "description": "A. FUMIGATUS #3 AB", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.0, "discounted_cash": 15.0, "minimum": 9.03, "maximum": 214.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.66 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.7 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN, R/O ASCITES", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2743.0, "discounted_cash": 111.0, "minimum": 60.62, "maximum": 2743.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 133.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1304.65, "10th_percentile": 1304.65, "90th_percentile": 1304.65, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 105.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 156.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 180.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 551.58 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 66.19 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 107.12 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 549.77 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 549.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 538.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.62 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.48, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 549.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN XR COMPL ACUTE", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1037.0, "discounted_cash": 111.0, "minimum": 35.58, "maximum": 1037.0, "payers_information": [ { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 373.81 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 373.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 365.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.58 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.48, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 373.81 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 133.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 105.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 156.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 180.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 324.78 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 38.97 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 48.68 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "A. PULLULANS AB", "code_information": [ { "code": "86331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.0, "discounted_cash": 11.0, "minimum": 7.188, "maximum": 240.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.41, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.45 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.45 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.45 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABD/PEL ANGIO W/WO CONT", "code_information": [ { "code": "74174", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7698.0, "discounted_cash": 372.0, "minimum": 286.05, "maximum": 7698.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 446.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 466.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 353.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 466.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 520.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.74 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1460.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 427.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.74 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 466.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 824.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 558.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 286.05 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 466.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 466.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 822.54, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9344.0, "minimum": 5877.2419, "maximum": 15138.2034, "payers_information": [ { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8628.46 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9438.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 14484.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 11454.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 11454.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 11213.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10279.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9811.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9811.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14016.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9624.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9624.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9811.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8144.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11454.44 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9624.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11213.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9811.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 10627.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 10376.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10477.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8877.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11650.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9344.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11680.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14372.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13082.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 15138.2, "additional_payer_notes": "162.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN/PELVIS W/O CONTRAST", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7672.0, "discounted_cash": 254.0, "minimum": 106.49, "maximum": 7672.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 305.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 279.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 241.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 343.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 356.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 412.19, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 1585.14, "10th_percentile": 1585.14, "90th_percentile": 1585.14, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1460.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 292.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 279.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 824.0 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 2301.6, "10th_percentile": 2301.6, "90th_percentile": 2301.6, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.49 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 381.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 562.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Abd paracentesis w/imaging", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2085.0, "discounted_cash": 967.0, "minimum": 99.28, "maximum": 2166.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1160.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1063.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2085.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 906.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 918.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 906.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1305.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1354.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1566.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2085.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1499.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1112.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.35 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 906.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1063.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.35 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1450.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 996.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 996.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.28 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 905.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 906.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2085.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1208.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 996.2, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN LIMITED", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2743.0, "discounted_cash": 111.0, "minimum": 60.62, "maximum": 2743.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 133.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1304.65, "10th_percentile": 1304.65, "90th_percentile": 1304.65, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 105.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 156.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 180.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 551.58 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 66.19 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 107.12 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 549.77 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 549.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.12 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 538.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.12 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.62 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.48, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 549.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABSCESS CULTURE", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.0, "discounted_cash": 8.0, "minimum": 5.172, "maximum": 335.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.42 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 9.56 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.1 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN/PELVIS W/WO CONTRAST", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11594.0, "discounted_cash": 372.0, "minimum": 252.53, "maximum": 11594.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 446.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 353.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 520.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1460.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 427.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 824.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 558.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 252.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 252.53 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 381.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 822.54, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN KUB 1 VIEW", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 852.0, "discounted_cash": 92.0, "minimum": 21.86, "maximum": 852.0, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 289.68, "10th_percentile": 289.68, "90th_percentile": 289.68, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 24.26 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 255.6, "10th_percentile": 255.6, "90th_percentile": 255.6, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.16, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 115.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 88.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 129.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.19 } ] } ] }, { "description": "ABDOMEN W/WO CONTRAST - 74170 - 35000005", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5989.0, "discounted_cash": 187.0, "minimum": 177.688, "maximum": 5989.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 224.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 177.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 252.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 261.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1460.0 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2013.38 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2013.38 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1971.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 824.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.48 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 381.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 413.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 233.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2013.38 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABSCESSOGRAM - 49424 - 36080010", "code_information": [ { "code": "49424", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2399.0, "minimum": 34.18, "maximum": 2399.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1775.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2399.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.18 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 411.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 3", "code_information": [ { "code": "2513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5308.12, "maximum": 5573.53, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5573.53, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5573.53, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMEN W/O CONTRAST", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4726.0, "discounted_cash": 254.0, "minimum": 131.19, "maximum": 4726.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1935.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 305.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 279.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1582.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 241.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 343.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 356.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 412.19, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1200.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 500.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2070.0 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1935.29 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1935.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 292.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1894.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 279.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 302.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 562.57, "additional_payer_notes": "221.10% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN W/WO CONTRAST - 74183 - 61000005", "code_information": [ { "code": "74183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6367.0, "discounted_cash": 372.0, "minimum": 241.55, "maximum": 6367.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 446.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1582.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 353.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 520.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1200.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 500.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2070.0 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2731.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2731.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 427.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2674.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1910.1, "10th_percentile": 1910.1, "90th_percentile": 1910.1, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 558.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 241.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 241.55 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 510.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 822.54, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2731.66 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABSCESSOGRAM - 76080 - 32009050", "code_information": [ { "code": "76080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1129.0, "discounted_cash": 582.0, "minimum": 35.92, "maximum": 1129.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 699.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 640.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 611.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 553.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 786.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 815.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 943.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.85 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 39.34 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 49.89 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 417.64 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 417.64 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 670.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 617.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.05 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 408.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 640.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 611.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.05 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 611.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 874.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 600.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 600.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 611.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.92 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1129.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 728.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 417.64 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 600.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ablate inf turbinate submuc", "code_information": [ { "code": "30802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49291.0, "discounted_cash": 1654.0, "minimum": 194.18, "maximum": 49291.0, "payers_information": [ { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194.18 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3281.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3658.21, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2068.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2213.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1704.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1985.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1820.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1775.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1571.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2233.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2316.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2680.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3447.29 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2564.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 2213.85 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 2213.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1902.73, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1753.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3447.29 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 2167.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1820.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1442.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3447.29 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2481.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1704.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3447.29 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1704.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN WITH CONTRAST", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5444.0, "discounted_cash": 187.0, "minimum": 176.81, "maximum": 5444.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 224.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 177.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 252.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 261.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1460.0 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1691.13 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1691.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1655.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 824.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.81 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 381.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 413.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 233.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1691.13 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN/PELVIS WITH CONTRAST", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9474.0, "discounted_cash": 372.0, "minimum": 222.78, "maximum": 9474.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 446.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 353.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 520.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 3221.16, "10th_percentile": 3221.16, "90th_percentile": 3221.16, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1460.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 427.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 824.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 558.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.78 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 381.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 381.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 822.54, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.2, "median_amount": 381.74, "10th_percentile": 381.74, "90th_percentile": 381.74, "count": "1 through 10" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACID PHOSPHOTASE, PROSTATIC", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.0, "discounted_cash": 9.0, "minimum": 5.5, "maximum": 74.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.86 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.53 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 60.43 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 60.43 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.59, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 60.43 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 1", "code_information": [ { "code": "5431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4266.58, "maximum": 4479.91, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4479.91, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4479.91, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 1", "code_information": [ { "code": "2511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3113.86, "maximum": 3269.55, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3269.55, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3269.55, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 2", "code_information": [ { "code": "2512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4021.41, "maximum": 4222.48, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4222.48, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4222.48, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACROMIOCLAVICULAR JOINTS", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.0, "discounted_cash": 92.0, "minimum": 21.86, "maximum": 698.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 88.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 129.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.87 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 42.6 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 223.47 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 223.47 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 218.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.16, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 115.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 223.47 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 2", "code_information": [ { "code": "5432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5982.48, "maximum": 6281.6, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6281.6, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6281.6, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 4", "code_information": [ { "code": "2514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8971.17, "maximum": 9419.73, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9419.73, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9419.73, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABLATION BONE TUMOR(S)", "code_information": [ { "code": "20982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9823.0, "discounted_cash": 18697.0, "minimum": 352.64, "maximum": 9823.0, "payers_information": [ { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 352.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 352.64 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9823.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1775.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 9823.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 9823.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 9823.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9823.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 1", "code_information": [ { "code": "1931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5046.2, "maximum": 5298.51, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5298.51, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5298.51, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 4", "code_information": [ { "code": "5434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23643.17, "maximum": 24825.33, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24825.33, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24825.33, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 3", "code_information": [ { "code": "5433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7975.09, "maximum": 8373.84, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8373.84, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8373.84, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABLATION,ONE ORMORE RENA TUMOR", "code_information": [ { "code": "50592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8194.0, "discounted_cash": 6446.0, "minimum": 318.54, "maximum": 8194.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7736.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7091.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3368.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6769.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3635.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6124.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3635.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8194.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8194.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8194.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3817.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8194.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 8194.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8194.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7413.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6833.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3817.34 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8194.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3635.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7091.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6769.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3817.34 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6769.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8194.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6640.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3817.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6640.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6769.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 318.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 318.54 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3633.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3635.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8194.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8058.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8194.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6640.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 3", "code_information": [ { "code": "1933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9845.88, "maximum": 10338.17, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10338.17, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10338.17, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8111.0, "minimum": 4376.63, "maximum": 31334.4413, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9733.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8516.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8916.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8706.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8790.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7705.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9775.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10139.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12058.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11355.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 13140.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7239.58 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 12572.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 8765.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8765.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8581.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8922.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8516.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8516.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12167.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8354.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8354.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8516.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4376.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8111.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8765.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8354.7, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 2", "code_information": [ { "code": "5642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3860.1, "maximum": 4053.1, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4053.1, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4053.1, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 1", "code_information": [ { "code": "5641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2724.84, "maximum": 2861.08, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2861.08, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2861.08, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8786.0, "minimum": 5937.0642, "maximum": 25794.95, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10544.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9226.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9853.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9621.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9714.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8347.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10802.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10983.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 13325.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12301.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 14234.62, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8000.28 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8874.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 13619.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 25794.95 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 25794.95 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 25251.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9665.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9226.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9226.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13180.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9050.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9050.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9226.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10368.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25794.95 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9050.4, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 3", "code_information": [ { "code": "5643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5313.2, "maximum": 5578.86, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5578.86, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5578.86, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABSCESS DRAIN", "code_information": [ { "code": "75989", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1791.0, "minimum": 59.94, "maximum": 1791.0, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 253.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 253.86 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 266.55 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 618.86 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 618.86 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 266.55 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 605.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 253.86 }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 266.55 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 266.55 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.94 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 253.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 253.86 }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 618.86 } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 4", "code_information": [ { "code": "5644", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15266.36, "maximum": 16029.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16029.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16029.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 2", "code_information": [ { "code": "1452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3979.42, "maximum": 4178.39, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4178.39, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4178.39, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABSCESS DRAINAGE W/CATH PLAC", "code_information": [ { "code": "75989", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1791.0, "minimum": 59.94, "maximum": 1791.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1460.0 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 618.86 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 618.86 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 605.83 }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 824.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.94 }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 618.86 } ] } ] }, { "description": "ABSORPTION", "code_information": [ { "code": "86978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.0, "discounted_cash": 62.0, "minimum": 27.0, "maximum": 130.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 75.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 59.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 84.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 88.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 101.9, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.73 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 37.14 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 57.85 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.73 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.73 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 64.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 64.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABSCESS CATH CHANGE", "code_information": [ { "code": "49423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2517.0, "discounted_cash": 2046.0, "minimum": 65.46, "maximum": 2517.0, "payers_information": [ { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2517.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 2517.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 2517.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2353.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2169.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.35 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 2517.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 906.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2250.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2148.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.35 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2148.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2517.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2107.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2107.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2148.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.46 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 905.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 906.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2517.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2517.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2517.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2455.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2250.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1775.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2148.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 906.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1943.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 906.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2517.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2517.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2517.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2517.0 } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 4", "code_information": [ { "code": "1454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7821.66, "maximum": 8212.74, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8212.74, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8212.74, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACETAMINOPHEN (TYLENOL)", "code_information": [ { "code": "80143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 358.0, "discounted_cash": 18.0, "minimum": 11.184, "maximum": 358.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 218.74, "10th_percentile": 218.74, "90th_percentile": 218.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.2, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.64 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.03 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE HEPATITIS PANEL (A,B,C)", "code_information": [ { "code": "80074", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 688.0, "discounted_cash": 47.0, "minimum": 9.2, "maximum": 688.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 52.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 50.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 66.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 77.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.51 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 53.33 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 126.04 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 466.01 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 466.01 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.77, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 456.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 52.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.06 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 50.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.16, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 466.01 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACETYLCHOLINE BINDING AB", "code_information": [ { "code": "86041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.0, "discounted_cash": 18.0, "minimum": 11.04, "maximum": 67.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.81, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.04, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACETYLCHOLINE RECEPTOR BLOCK", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 308.0, "discounted_cash": 18.0, "minimum": 11.04, "maximum": 308.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.81, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 31.05 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.04, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.67 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 150.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5655.67, "maximum": 5938.45, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5938.45, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5938.45, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACP ABD/PEL/L EXT 1ST", "code_information": [ { "code": "36245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3920.0, "minimum": 231.05, "maximum": 3920.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3920.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.05 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 858.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 } ] } ] }, { "description": "ACETONE, QUANTITATIVE", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.0, "discounted_cash": 8.0, "minimum": 4.902, "maximum": 166.0, "payers_information": [ { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 76.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.05 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.88 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 76.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 76.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 74.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACHR GANGANGLIONIC (ALPHA3) AB", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 308.0, "discounted_cash": 18.0, "minimum": 11.04, "maximum": 308.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.81, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 31.05 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.04, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.67 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 150.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 1", "code_information": [ { "code": "1901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5192.13, "maximum": 5451.74, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5451.74, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5451.74, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACP ABD/PEL/L EXT 2-3 OR ADD", "code_information": [ { "code": "36248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 803.0, "minimum": 44.87, "maximum": 803.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 803.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 803.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 803.0 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 803.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 803.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 803.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 803.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 803.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 803.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.87 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 803.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 803.0 } ] } ] }, { "description": "ACETYCHOLINE REC MODULATING AB", "code_information": [ { "code": "86043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 43.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACID FAST STAIN", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.0, "discounted_cash": 55.0, "minimum": 40.49, "maximum": 240.0, "payers_information": [ { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 118.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 57.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 57.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.28 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.87, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 66.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 75.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 77.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 96.35 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 120.53 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.26 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.91, "additional_payer_notes": "115.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 3", "code_information": [ { "code": "1903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7248.77, "maximum": 7611.21, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7611.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7611.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACP THOR/BRACH 2ND", "code_information": [ { "code": "36216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2675.0, "minimum": 274.75, "maximum": 2675.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2675.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 274.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 274.75 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 858.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 } ] } ] }, { "description": "ACETYLCHOLINE RECEPTOR BINDING", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 308.0, "discounted_cash": 18.0, "minimum": 11.04, "maximum": 308.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.81, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 31.05 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.04, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.67 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 150.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACP PULMONARY 3RD", "code_information": [ { "code": "36015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1209.0, "minimum": 162.9, "maximum": 1813.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1209.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1209.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.9 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 858.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 4", "code_information": [ { "code": "1904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10518.54, "maximum": 11044.47, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11044.47, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11044.47, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACP THOR/BRACH 3RD", "code_information": [ { "code": "36217", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3185.0, "minimum": 343.73, "maximum": 3185.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3185.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 343.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 343.73 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 858.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 } ] } ] }, { "description": "ACETYLCHOLINE RECEPTOR MODULE", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.0, "discounted_cash": 11.0, "minimum": 6.918, "maximum": 375.0, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.22 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 119.15, "10th_percentile": 119.15, "90th_percentile": 119.15, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.67 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 26.79 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.22 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.22 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ACP THOR/BRACH 1ST", "code_information": [ { "code": "36215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2263.0, "minimum": 205.83, "maximum": 2263.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2263.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2263.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.83 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 858.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8705.0, "minimum": 5869.3726, "maximum": 39349.63, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10446.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9141.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9741.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9511.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9603.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8270.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10679.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10882.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 13173.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12188.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 14103.41, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7909.07 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8792.87, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 13494.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 39349.63 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 39349.63 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 38521.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9576.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9141.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9141.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13058.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8966.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8966.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9141.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9798.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8705.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39349.63 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8966.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 4", "code_information": [ { "code": "1934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15300.75, "maximum": 16065.79, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16065.79, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16065.79, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACTH STIMULATION PANEL", "code_information": [ { "code": "80400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.0, "discounted_cash": 32.0, "minimum": 19.572, "maximum": 314.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 30.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 44.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.84, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.21 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 36.78 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 131.52 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 35.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.3 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.62 }, { "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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.14, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACYLCARNITINE, PLASMA QNT", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 224.0, "discounted_cash": 16.0, "minimum": 10.122, "maximum": 224.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 19.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.97 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.46 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 1", "code_information": [ { "code": "7561", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2916.8, "maximum": 3062.64, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3062.64, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3062.64, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACTIVATED COAG TIME", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.0, "discounted_cash": 4.0, "minimum": 2.568, "maximum": 282.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.71 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 4.78 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.87 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.87 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACYLCARNITINE, QUANT", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 224.0, "discounted_cash": 16.0, "minimum": 10.122, "maximum": 224.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 19.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.97 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.46 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 3", "code_information": [ { "code": "7563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3954.48, "maximum": 4152.2, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4152.2, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4152.2, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 4", "code_information": [ { "code": "4694", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11724.59, "maximum": 12310.82, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12310.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12310.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADALIMUMAB ACT&NEUT AB", "code_information": [ { "code": "86352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1204.0, "discounted_cash": 135.0, "minimum": 41.57, "maximum": 1204.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 183.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 190.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 220.09, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.65 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 565.28 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 152.63 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 314.77 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.65 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 149.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 142.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.65 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 203.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.03, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 169.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 163.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 149.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 142.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 129.07, "additional_payer_notes": "95.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 3", "code_information": [ { "code": "1453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5134.34, "maximum": 5391.06, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5391.06, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5391.06, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10951.32, "maximum": 11498.89, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11498.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11498.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADAMTS-13 ACTIVITY", "code_information": [ { "code": "85397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.0, "discounted_cash": 30.0, "minimum": 14.784, "maximum": 64.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 43.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.99, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.08 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 34.57 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 52.97 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.08 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.75 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 31.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 31.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "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": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.03, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 3", "code_information": [ { "code": "4693", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6266.8, "maximum": 6580.14, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6580.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6580.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACID REFLUX TEST W/PH PROBE", "code_information": [ { "code": "91034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2556.0, "discounted_cash": 397.0, "minimum": 156.58, "maximum": 2556.0, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 488.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 879.8, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 497.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 409.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 477.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 437.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 417.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 378.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 537.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 557.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 644.63, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 512.94 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 616.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 421.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 512.94 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 437.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 417.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 512.94 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 417.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 596.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 409.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 512.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 409.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 417.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.58 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43629.0, "minimum": 18724.2266, "maximum": 166912.52, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 52355.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45811.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 58185.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 56813.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 57363.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41448.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 63788.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 54537.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 78689.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 61081.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 70680.55, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 47241.85 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 44066.3, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 67626.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 166912.52 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 166912.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 163398.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 47993.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45811.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 45811.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 65444.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 44938.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 44938.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 45811.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 43629.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43629.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 86889.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 43629.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43630.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 166912.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 44938.9, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20399.33, "maximum": 21419.3, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 21419.3, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 21419.3, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACP ABD/PEL/L EXT 2ND", "code_information": [ { "code": "36246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4190.0, "minimum": 250.29, "maximum": 4190.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4190.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.29 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 858.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10571.0, "minimum": 4606.58, "maximum": 18450.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12686.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11100.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12329.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12038.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12155.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10043.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13516.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13214.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16674.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14800.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 17126.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10010.46 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10677.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 16386.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 14339.49 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 14339.49 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 14037.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11628.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11100.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11100.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15857.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10888.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10888.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11100.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10571.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10571.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4606.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10571.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10571.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14339.49 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10888.85, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS QT BY PCR", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 921.0, "discounted_cash": 42.0, "minimum": 25.704, "maximum": 921.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 286.46 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 51.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 57.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.44 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 48.18 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 99.24 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 286.46 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 286.46 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 280.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.12 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.41, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.55, "additional_payer_notes": "125.00% 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": 17620.0, "minimum": 10947.4515, "maximum": 115699.41, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21144.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18501.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 22106.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 21585.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21794.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16739.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24235.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 22025.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 29896.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 24668.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 28544.76, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 17948.79 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17796.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 27311.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 115699.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 115699.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 113263.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 19382.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18501.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18501.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26430.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18148.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18148.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 18501.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17620.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19254.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17620.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 115699.41 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18148.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACP ABD/PEL/L EXT 3RD ORD", "code_information": [ { "code": "36247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4983.0, "minimum": 286.55, "maximum": 4983.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.64 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 286.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 286.55 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 858.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 858.7 } ] } ] }, { "description": "ADMIN OF INFLUENZA VIRUS VACCN", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 49.0, "minimum": 15.0, "maximum": 136.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 47.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 67.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 54.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 48.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.37, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11001.0, "minimum": 6100.8, "maximum": 61317.2809, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13201.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11551.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12925.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12620.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12742.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10451.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14169.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13751.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 17479.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15401.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 17821.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10494.08 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11111.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 17051.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 28926.77 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 28926.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 28317.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12101.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11551.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11551.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16501.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11331.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11331.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11551.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11001.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11001.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13458.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11001.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11001.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28926.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11331.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACTIVATED CLOTTING TIME - SURG", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.0, "discounted_cash": 4.0, "minimum": 2.568, "maximum": 282.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.71 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 4.78 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.87 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.21 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.87 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADMN SARSCOV2 VACC 1 DOSE", "code_information": [ { "code": "90480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.0, "discounted_cash": 43.0, "minimum": 21.4, "maximum": 107.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 52.01, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 45.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 41.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 58.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 60.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.21, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.84, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 47.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 45.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 65.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 48.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.82, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7687.0, "minimum": 2954.01, "maximum": 12453.426, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9224.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8071.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8328.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8132.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8210.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7302.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9130.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9609.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11263.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10762.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12453.43, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6761.99 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7764.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 11915.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 8322.13 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8322.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8146.93 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8456.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8071.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8071.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11530.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7917.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7917.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8071.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2954.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8322.13 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7917.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 2", "code_information": [ { "code": "1932", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7433.36, "maximum": 7805.03, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7805.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7805.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADENOSINE DEAMINASE,PERICARD F", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.0, "discounted_cash": 8.0, "minimum": 4.86, "maximum": 32.0, "payers_information": [ { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.32, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.43 } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12374.0, "minimum": 3813.0, "maximum": 44509.6862, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14849.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12993.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14830.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14481.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14621.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11756.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16258.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15468.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 20056.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17324.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 20047.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 12041.3 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12498.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 19181.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 33151.29 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 33151.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 32453.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13612.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12993.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12993.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18562.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12746.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12746.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 12993.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12374.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15730.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12374.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33151.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12746.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7208.0, "minimum": 4321.4, "maximum": 33813.19, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8649.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7568.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7663.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7483.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7555.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6847.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8401.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9010.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10364.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10091.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11677.33, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6222.44 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7280.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 11172.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 33813.19 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 33813.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 33101.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7929.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7568.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7568.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10812.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7424.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7424.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7568.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8789.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7208.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33813.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7424.48, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9019.0, "minimum": 3273.2, "maximum": 14612.1408, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6267.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9827.44 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9290.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10823.81, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9470.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 10176.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9936.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10033.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8568.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11156.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11274.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 13763.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12627.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 14612.14, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8262.74 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9110.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 13980.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 9827.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 9827.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 9620.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9921.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9470.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9470.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13529.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9290.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9290.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9470.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9019.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS QL BY PCR", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.0, "discounted_cash": 35.0, "minimum": 21.054, "maximum": 157.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.85, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 39.35 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 81.6 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.35, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.88 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 1", "code_information": [ { "code": "4011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8705.1, "maximum": 9140.36, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9140.36, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9140.36, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14725.0, "minimum": 7347.81, "maximum": 34922.48, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 17670.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15461.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 18090.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 17664.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17835.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13988.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19832.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18406.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 24465.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 20615.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 23854.76, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 14688.27 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14872.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 22824.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 34922.48 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 34922.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 34187.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16197.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15461.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15461.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22087.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15166.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15166.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15461.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14725.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14725.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7347.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14725.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14725.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34922.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15166.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 1", "code_information": [ { "code": "7551", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1960.2, "maximum": 2058.21, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2058.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2058.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 2", "code_information": [ { "code": "4012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15339.83, "maximum": 16106.82, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16106.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16106.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADALIMUMAB LEVEL AB IBD", "code_information": [ { "code": "80145", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 38.0, "minimum": 12.35, "maximum": 140.0, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 52.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 54.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.48, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 43.4 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.36, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 42.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.93 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 39.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 39.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22360.0, "minimum": 15322.8413, "maximum": 62578.07, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 26832.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23478.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 28682.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 28005.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 28277.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21242.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 31444.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 27950.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 38789.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 31304.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 36224.04, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 23287.47 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 22584.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 34658.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 62578.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 62578.07 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 61260.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 24596.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23478.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 23478.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33540.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23031.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 23031.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 23478.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22360.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22360.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28528.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22360.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22360.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62578.07 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 23031.32, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 4", "code_information": [ { "code": "7554", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7766.36, "maximum": 8154.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8154.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8154.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AE1/AE3", "code_information": [ { "code": "88342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 716.0, "discounted_cash": 181.0, "minimum": 71.1, "maximum": 716.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 254.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 296.91 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 80.17 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 119.92 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 281.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 193.75 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 193.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 189.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.83 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 401.69, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VNA Health Care", "plan_name": "VNA Health Care Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.1 }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 193.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 2", "code_information": [ { "code": "7552", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2873.98, "maximum": 3017.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3017.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3017.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 2", "code_information": [ { "code": "7562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3814.79, "maximum": 4005.53, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4005.53, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4005.53, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADL TRAINING/EA 15", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.0, "discounted_cash": 33.0, "minimum": 24.2, "maximum": 121.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 34.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 31.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 44.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 46.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.82, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.96 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22 }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.0 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 80.89 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 80.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.96 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 79.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 36.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 34.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 34.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 34.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.22 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.54, "additional_payer_notes": "A Indicator - 110.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 80.89 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AEROSOL TREATMENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 395.0, "discounted_cash": 233.0, "minimum": 9.17, "maximum": 395.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 280.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 256.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 221.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 315.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 326.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.95 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 361.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.53, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 247.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.95 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 256.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.95 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 350.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 240.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 240.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 395.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.51, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADMIN OF PNEUMOCOCCAL VACCINE", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 49.0, "minimum": 15.0, "maximum": 136.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 47.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 67.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 54.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 48.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.37, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 4", "code_information": [ { "code": "7564", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8171.71, "maximum": 8580.3, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8580.3, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8580.3, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADMIN HEP B VACCINE", "code_information": [ { "code": "G0010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 49.0, "minimum": 15.0, "maximum": 136.0, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 54.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 48.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.37, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 47.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 67.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.79 } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10773.0, "minimum": 5634.8629, "maximum": 66117.76, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12928.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11312.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12609.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12311.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12431.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10234.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13823.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13466.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 17052.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15082.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 17452.88, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10237.64 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10881.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 16698.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 66117.76 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 66117.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 64725.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11850.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11312.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11312.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16160.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11096.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11096.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11312.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10773.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10773.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23536.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10773.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10773.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 66117.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11096.6, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 1", "code_information": [ { "code": "1451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3113.45, "maximum": 3269.12, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3269.12, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3269.12, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADMINISTRATION CHARGE", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.0, "discounted_cash": 9.0, "minimum": 3.43, "maximum": 69.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "percent of total billed charges", "standard_charge_percentage": 23.1, "median_amount": 450.3, "10th_percentile": 450.3, "90th_percentile": 450.3, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.2, "median_amount": 12.73, "10th_percentile": 12.73, "90th_percentile": 867.0, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.54 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 655.2, "10th_percentile": 106.5, "90th_percentile": 1041.0, "count": "79" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10287.0, "minimum": 7191.2746, "maximum": 18600.1, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14881.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10287.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18600.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10596.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12344.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10801.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11935.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11653.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11766.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9773.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13084.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12859.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16141.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14402.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 16665.64, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9690.35 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10390.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 15945.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 18600.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 18600.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 18208.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11316.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10287.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10801.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10801.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15431.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10596.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10596.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10801.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10287.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10287.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADOLESCENT IOP DAILY", "code_information": [ { "code": "G0410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 560.0, "minimum": 112.0, "maximum": 560.0, "payers_information": [ { "payer_name": "APS Healthcare", "plan_name": "APS Healthcare Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 140.0 }, { "payer_name": "Beacon (fka Value Options)", "plan_name": "Beacon (fka Value Options) Commercial Non HMO Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 255.0 }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 380.0 }, { "payer_name": "ComPsych", "plan_name": "ComPsych Commercial", "methodology": "fee schedule", "standard_charge_dollar": 560.0 }, { "payer_name": "Evernorth Behavioral Health", "plan_name": "Evernorth Behavioral Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 391.0 }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "fee schedule", "standard_charge_dollar": 560.0 }, { "payer_name": "Magellan", "plan_name": "Magellan Commercial Pinnacle Network", "methodology": "per diem", "standard_charge_dollar": 178.0 }, { "payer_name": "Magellan", "plan_name": "Magellan Commercial Summit Network", "methodology": "per diem", "standard_charge_dollar": 204.0 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 295.62 }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.0 }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 1", "code_information": [ { "code": "4691", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3095.99, "maximum": 3250.79, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3250.79, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3250.79, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL CORTEX AB", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 308.0, "discounted_cash": 18.0, "minimum": 11.04, "maximum": 308.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.81, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 31.05 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.04, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.67 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 150.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15932.0, "minimum": 10108.9997, "maximum": 59651.1, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 19118.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16729.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 19765.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 19299.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19486.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15135.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21668.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19915.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 26730.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 22305.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 25810.47, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 16047.89 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16091.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 24695.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 59651.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 59651.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 58395.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17525.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16729.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16729.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23898.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16410.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16410.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 16729.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15932.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15932.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19660.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15932.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15932.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59651.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16410.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFB CULTURE; ISOLATION & ID", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.0, "discounted_cash": 10.0, "minimum": 6.48, "maximum": 401.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 161.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.95 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 12.14 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 24.96 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 161.52 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 161.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.66 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 2", "code_information": [ { "code": "4692", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4015.18, "maximum": 4215.94, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4215.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4215.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENOCORTICOTROPHIC HORMONE", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 771.0, "discounted_cash": 38.0, "minimum": 23.172, "maximum": 771.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.56, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.73 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 43.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 89.5 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.17, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 249.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 249.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 244.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 42.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.34, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 249.66 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFP, TOTAL AND L3 PERCENT", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.0, "discounted_cash": 64.0, "minimum": 28.68, "maximum": 300.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 77.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 70.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 61.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 86.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 104.34, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.34 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 72.45 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 149.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.65, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.11 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 70.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.39 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 66.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 66.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.29, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 4", "code_information": [ { "code": "6904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35517.57, "maximum": 37293.45, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 37293.45, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 37293.45, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADULT IOP DAILY", "code_information": [ { "code": "G0410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 560.0, "minimum": 112.0, "maximum": 560.0, "payers_information": [ { "payer_name": "APS Healthcare", "plan_name": "APS Healthcare Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 140.0 }, { "payer_name": "Beacon (fka Value Options)", "plan_name": "Beacon (fka Value Options) Commercial Non HMO Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 255.0 }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 380.0 }, { "payer_name": "ComPsych", "plan_name": "ComPsych Commercial", "methodology": "fee schedule", "standard_charge_dollar": 560.0 }, { "payer_name": "Evernorth Behavioral Health", "plan_name": "Evernorth Behavioral Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 391.0 }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "fee schedule", "standard_charge_dollar": 560.0 }, { "payer_name": "Magellan", "plan_name": "Magellan Commercial Pinnacle Network", "methodology": "per diem", "standard_charge_dollar": 178.0 }, { "payer_name": "Magellan", "plan_name": "Magellan Commercial Summit Network", "methodology": "per diem", "standard_charge_dollar": 204.0 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 295.62 }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.0 }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN - 82040 - 30000520", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.0, "discounted_cash": 4.0, "minimum": 2.97, "maximum": 144.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.43 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 48.96, "10th_percentile": 48.96, "90th_percentile": 48.96, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.52 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.97, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.62 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.62 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.18 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.62 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AGGLUTININS, FEBRILE, EA AG", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.0, "discounted_cash": 6.0, "minimum": 4.188, "maximum": 51.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 9.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.6 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 7.72 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.43 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 2", "code_information": [ { "code": "1902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5660.25, "maximum": 5943.26, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5943.26, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5943.26, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29328.0, "minimum": 18450.0, "maximum": 83633.42, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 35194.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30795.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 38348.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 37444.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 37806.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27862.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 42040.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 36661.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 51861.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 41060.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 47512.74, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 31135.44 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 29622.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 45459.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 83633.42 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 83633.42 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 81872.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 32261.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30795.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 30795.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 43993.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 30208.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 30208.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 30795.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 29328.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29328.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37780.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29328.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29328.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 83633.42 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 30208.66, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13939.0, "minimum": 8250.7607, "maximum": 53181.15, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13939.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14535.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13939.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 53181.15 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14357.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 16727.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14636.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 17001.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 16600.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16761.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13242.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18638.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17424.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 22992.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 19515.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 22582.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 13803.65 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14079.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 21606.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 53181.15 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 53181.15 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 52061.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15333.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14636.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14636.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20909.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14357.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14357.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 14636.69, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AEROSOL SUBSEQUENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 395.0, "discounted_cash": 233.0, "minimum": 9.17, "maximum": 395.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 280.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 256.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 221.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 315.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 326.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 361.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.53, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 247.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 256.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 350.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 240.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 240.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 395.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.51, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12499.0, "minimum": 7022.46, "maximum": 34200.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14999.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13124.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 15003.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14649.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14791.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11874.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16448.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15624.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 20290.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17499.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 20249.06, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 12181.56 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12624.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 19374.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 17027.26 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 17027.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 16668.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13749.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13124.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13124.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18749.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12874.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12874.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13124.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12499.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7022.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12499.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17027.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12874.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6972.0, "minimum": 4067.2, "maximum": 30117.57, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8366.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7320.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7336.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7163.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7232.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6623.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8042.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8715.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9921.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9760.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11294.85, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5956.54 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7041.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 10806.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 30117.57 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 30117.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 29483.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7669.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7320.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7320.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10458.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7181.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7181.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7320.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7847.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6972.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30117.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7181.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFB SMEAR", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.0, "discounted_cash": 6.0, "minimum": 4.008, "maximum": 32.0, "payers_information": [ { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.24 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.01, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "115.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, ETHANOL, URINE", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.0, "discounted_cash": 114.0, "minimum": 46.431, "maximum": 798.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 261.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN SERUM", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.0, "discounted_cash": 4.0, "minimum": 2.97, "maximum": 144.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.43 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 48.96, "10th_percentile": 48.96, "90th_percentile": 48.96, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.52 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.97, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.62 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.62 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.18 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.62 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16817.0, "minimum": 6213.8794, "maximum": 41455.55, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18499.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17658.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17658.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25226.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17322.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17322.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 17658.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16817.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16817.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26980.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16817.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41455.55 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17322.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 20181.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17658.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 20993.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 20498.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20697.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15977.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23015.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 21022.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 28391.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 23545.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 27245.08, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 17045.24 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16986.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 26067.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 41455.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 41455.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 40582.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16818.0, "additional_payer_notes": "100.00% 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": 7825.0, "minimum": 5133.7054, "maximum": 18184.7224, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9390.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8216.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8520.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8319.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8399.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7434.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9340.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9782.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11522.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10955.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12677.47, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6917.74 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7903.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 12129.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 10929.03 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 10929.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 10698.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8608.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8216.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8216.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11738.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8060.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8060.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8216.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9532.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7825.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10929.03 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8060.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 4", "code_information": [ { "code": "2804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14171.19, "maximum": 14879.75, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14879.75, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14879.75, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCHOL, UR CONFIRMATION", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.0, "discounted_cash": 114.0, "minimum": 46.431, "maximum": 798.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 372.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6259.0, "minimum": 3304.6, "maximum": 28241.9664, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7511.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6572.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6347.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6197.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6257.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5946.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6958.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 7824.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8584.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 8762.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10139.99, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5153.67 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6321.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 9701.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 14930.7 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 14930.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 14616.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6885.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6572.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6572.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9388.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6447.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6447.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 6572.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5946.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6259.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14930.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6447.03, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AGNA/SOX1 AB IFA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 282.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN ANIMAL PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 906.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 4", "code_information": [ { "code": "7724", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12180.65, "maximum": 12789.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12789.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12789.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADENOSINE DEAMINASE,PLEURAL FL", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.0, "discounted_cash": 8.0, "minimum": 4.86, "maximum": 32.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.43 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.32, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36543.0, "minimum": 19350.0, "maximum": 65395.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38370.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 48355.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 47215.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 47672.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34716.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 53011.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 45679.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 65395.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 51160.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 59200.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 39260.5 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36908.63, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 56641.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 43497.96 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 43497.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 42582.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 40197.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38370.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 38370.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 54814.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 37639.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 37639.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 38370.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36543.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36543.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51755.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 36543.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43497.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37639.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 43851.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 36543.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN CEREAL PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 906.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7751", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2516.45, "maximum": 2642.27, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2642.27, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2642.27, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALBUMIN GLYCATED", "code_information": [ { "code": "82985", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.0, "discounted_cash": 16.0, "minimum": 10.056, "maximum": 121.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.15, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.47 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 18.76 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.7 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.06, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.27 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.3 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN GROUP - 86003 - 30010700", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1293.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7752", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3446.87, "maximum": 3619.21, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3619.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3619.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 3", "code_information": [ { "code": "7553", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4505.33, "maximum": 4730.6, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4730.6, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4730.6, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN GROUP 28", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1293.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL CONFIRM CHARGE", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.0, "discounted_cash": 114.0, "minimum": 46.431, "maximum": 798.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 380.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18430.0, "minimum": 6863.4, "maximum": 49396.16, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19351.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 23230.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 22682.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 22902.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17508.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 25467.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23037.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 31416.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 25802.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 29856.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 18860.94 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 18614.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 28566.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 49396.16 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 49396.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 48356.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 20273.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19351.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19351.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27645.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18983.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18983.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 19351.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18430.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18430.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25940.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18430.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49396.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18983.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22116.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18430.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN, BODY FLUID", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.0, "discounted_cash": 7.0, "minimum": 4.668, "maximum": 141.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.69 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.96 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 85.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.28 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN SPECIFIC IgE ,QNT", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15017.0, "minimum": 5832.0, "maximum": 25019.06, "payers_information": [ { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 24327.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 15016.99 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15167.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 23276.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 25019.06 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 25019.06 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 24492.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16518.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15767.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15767.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22525.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15467.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15467.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15767.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15017.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15017.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25019.06 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15467.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18020.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15767.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 18495.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 18059.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 18234.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14266.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20276.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18771.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 25013.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21023.84, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "4013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19250.24, "maximum": 20212.75, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20212.75, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 20212.75, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN TREE PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1156.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8428.0, "minimum": 4009.5, "maximum": 14850.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10114.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8849.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9356.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9135.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9224.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8007.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10257.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10535.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12653.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11799.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 13654.09, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7596.7 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8512.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 13064.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 9117.34 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 9117.34 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8925.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9271.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8849.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8849.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12642.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8681.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8681.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8849.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8428.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9117.34 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.3, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 4", "code_information": [ { "code": "4014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32321.4, "maximum": 33937.47, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 33937.47, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 33937.47, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN, CATFISH", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 879.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, ISOPROPYL", "code_information": [ { "code": "84600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 295.0, "discounted_cash": 17.0, "minimum": 10.266, "maximum": 295.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 19.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 37.15 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 62.3 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 62.3 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 60.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.81 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.53, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 62.3 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG BEEF", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 2", "code_information": [ { "code": "2802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4424.68, "maximum": 4645.91, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4645.91, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4645.91, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFB CULTURE, BLOOD", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.0, "discounted_cash": 10.0, "minimum": 6.48, "maximum": 401.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.95 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 12.14 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 24.96 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 161.52 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 161.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.66 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 161.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 1", "code_information": [ { "code": "7721", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3063.97, "maximum": 3217.17, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3217.17, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3217.17, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN, IGG MUSHROOM", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALDOLASE", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.0, "discounted_cash": 9.0, "minimum": 5.5, "maximum": 149.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.86 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.53 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.78 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.78 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 106.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.78 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6479.0, "minimum": 4008.4922, "maximum": 18790.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6803.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6652.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6495.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6558.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6155.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7293.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8099.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8997.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9071.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10496.47, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5401.5 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6544.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 10042.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 8100.82 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8100.82 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 7930.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7127.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6803.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6803.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9718.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6673.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6673.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 6803.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18790.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8100.82 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6673.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7775.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 6479.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7753", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5865.62, "maximum": 6158.9, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6158.9, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6158.9, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN, IGG PEANUT", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALDOSTERONE, 24 HOUR URINE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 608.0, "discounted_cash": 40.0, "minimum": 24.45, "maximum": 608.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 38.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 55.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 66.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.9 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 45.6 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 306.76 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 306.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 300.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.09 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.9, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 306.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN - 84165 - 30010800", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 262.0, "discounted_cash": 10.0, "minimum": 5.5, "maximum": 262.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.95 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 12.14 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 24.96 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 174.84 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 174.84 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 171.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 174.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 160.08, "10th_percentile": 160.08, "90th_percentile": 160.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7754", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12993.83, "maximum": 13643.52, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13643.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13643.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN, IGG PORK", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALK PHOS, BONE SPECIFIC", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 135.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.33 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN, CSF", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.0, "discounted_cash": 7.0, "minimum": 4.668, "maximum": 141.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.69 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.96 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 85.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.28 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6396.0, "minimum": 2430.0, "maximum": 10362.7836, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7676.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6716.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6538.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6384.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6445.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6076.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7167.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 7995.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8842.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 8955.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10362.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5308.57 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6460.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 9915.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 7775.65 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 7775.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 7611.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7036.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6716.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6716.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9595.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6588.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6588.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 6716.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3681.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7775.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6588.68, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG SOYBEAN", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALKALINE PHOSPHATASE QUEST", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 135.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.33 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 3", "code_information": [ { "code": "2803", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6737.83, "maximum": 7074.72, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7074.72, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7074.72, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN, IGG WHEAT", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN FOOD ALLERGY PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1257.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 2", "code_information": [ { "code": "7722", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3767.82, "maximum": 3956.21, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3956.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3956.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALKALINE PHOSPHATASE", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 135.0, "payers_information": [ { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.33 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 1", "code_information": [ { "code": "8111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2137.3, "maximum": 2244.17, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2244.17, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2244.17, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN GROUP 20", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1293.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 3", "code_information": [ { "code": "7723", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4613.42, "maximum": 4844.09, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4844.09, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4844.09, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALKALINE PHOSPHATASE ISO QD", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.0, "discounted_cash": 14.0, "minimum": 8.868, "maximum": 163.0, "payers_information": [ { "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 123.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.3 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.55 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.1 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 123.84 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 123.84 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.43 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 2", "code_information": [ { "code": "8112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3179.55, "maximum": 3338.53, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3338.53, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3338.53, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN GROUP 30", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1293.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, ETOH", "code_information": [ { "code": "82077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 358.0, "discounted_cash": 17.0, "minimum": 10.362, "maximum": 358.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.19 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 19.49 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.04 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN DUST PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 955.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14531.0, "minimum": 5981.3751, "maximum": 25229.77, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 17438.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15258.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 17822.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 17402.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17571.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13805.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19539.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18164.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 24103.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 20344.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 23541.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 14470.55 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14677.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 22524.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 25229.77 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 25229.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 24698.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15985.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15258.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15258.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21797.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14967.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14967.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15258.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14531.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14691.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14531.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25229.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14967.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN INSECT VENOM PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 804.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, METHYL", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 295.0, "discounted_cash": 114.0, "minimum": 46.431, "maximum": 798.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 295.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN GRASS PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1156.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 3", "code_information": [ { "code": "0073", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 125164.59, "maximum": 131422.82, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 131422.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 131422.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN MOLD PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 906.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 1", "code_information": [ { "code": "2801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3428.99, "maximum": 3600.44, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3600.44, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3600.44, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN TOTAL IgE", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 224.0, "discounted_cash": 16.0, "minimum": 9.876, "maximum": 224.0, "payers_information": [ { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 114.46 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.11 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 18.39 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.37 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.88, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 114.46 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 114.46 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 112.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.87 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA GLOBIN HBA 1/2 DEL/DUP", "code_information": [ { "code": "81269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 784.0, "discounted_cash": 202.0, "minimum": 121.44, "maximum": 784.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 242.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 222.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 212.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 167.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 192.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 167.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 273.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 283.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 327.89, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 176.13 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 784.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 227.28 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.44, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 176.13 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 167.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 222.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 293.48 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 212.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 176.13 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 208.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 176.13 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 208.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 167.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.88, "additional_payer_notes": "A Indicator - 110.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 253.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PISTACHIO", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 503.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALDOSTERONE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 608.0, "discounted_cash": 40.0, "minimum": 24.45, "maximum": 608.0, "payers_information": [ { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 306.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 38.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 55.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 66.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.9 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 45.6 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 306.76 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 306.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 300.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.09 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.9, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN WEED PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1208.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA SUBUNIT", "code_information": [ { "code": "82397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 262.0, "discounted_cash": 14.0, "minimum": 8.472, "maximum": 341.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 19.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.57 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 32.89 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN SEAFOOD PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 955.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALICIAN BLUE STAIN", "code_information": [ { "code": "88313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 531.0, "discounted_cash": 141.0, "minimum": 40.49, "maximum": 693.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 191.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 229.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 292.82 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 79.06 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 96.78 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 95.75 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 95.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 93.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 156.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 313.67, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 177.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 95.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 170.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 156.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 134.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, FOOD BEEF IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 503.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 3", "code_information": [ { "code": "0523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5882.66, "maximum": 6176.79, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6176.79, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6176.79, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN, IGG CHEDDAR CHEESE", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN FOOD PANEL #1", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 906.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, FUNGI/MOLD IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 503.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALUMINUM SERUM", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.0, "discounted_cash": 25.0, "minimum": 12.54, "maximum": 227.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 35.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.25 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 28.69 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 59.06 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.64 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.64 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 164.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.95 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.64 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG EGG YOLK", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN GLUTEN", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 503.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG BROCCOLI", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMIKACIN, RANDOM", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.0, "discounted_cash": 15.0, "minimum": 9.048, "maximum": 157.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.43, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.66 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.7 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.87 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% 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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG LETTUCE", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN GROUP - 86003 - 30010720", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1257.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG CORN", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 } ] } ] }, { "description": "ALLERGEN, IGG OLIVES", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN IGG STRAWBERRY", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG EGG WHITE", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amphetamine-Serum", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.0, "discounted_cash": 114.0, "minimum": 46.431, "maximum": 798.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 372.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.61 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG SHRIMP", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN NUT PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 955.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG ONION", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPHETAMINES 5 OR MORE", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.0, "discounted_cash": 114.0, "minimum": 46.431, "maximum": 798.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 372.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG TURKEY", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, FOOD PORK IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 503.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, TILAPIA", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 757.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12261.0, "minimum": 8840.7784, "maximum": 43586.88, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14713.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12874.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14672.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14326.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14465.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11647.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16085.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15326.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 19843.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17165.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 19862.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 11913.08 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12383.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 19004.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 43586.88 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 43586.88 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 42669.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13487.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12874.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12874.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18391.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12628.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12628.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 12874.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12261.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12261.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15991.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12261.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12261.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43586.88 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12628.83, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN,BOTRYTIS CINEREA", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 757.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG BAKER'S YEAST", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN,HORMODENDRUM", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 757.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% 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": 34484.0, "minimum": 25928.4, "maximum": 107695.19, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 41380.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36208.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 45499.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 44426.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 44856.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 32759.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 49880.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 43105.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 61532.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 48277.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 55864.14, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 36941.39 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 34828.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 53450.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 107695.19 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 107695.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 105427.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 37932.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36208.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36208.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 51726.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 35518.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 35518.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 36208.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 34484.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34484.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55038.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 34484.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 107695.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 35518.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 4", "code_information": [ { "code": "8114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11947.84, "maximum": 12545.23, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12545.23, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12545.23, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN, IGG CHICKEN", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN-FORMALDEHYDE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 757.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amputation of finger/thumb", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17883.0, "discounted_cash": 3489.0, "minimum": 690.0, "maximum": 17883.0, "payers_information": [ { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 4736.09 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 4736.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2836.82 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 4636.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 4898.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2836.82 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2836.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 712.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 712.1 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2700.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4736.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3368.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2836.82 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 1", "code_information": [ { "code": "0071", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 87176.42, "maximum": 91535.24, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 91535.24, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 91535.24, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN, IGG CRAB", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 2", "code_information": [ { "code": "0072", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 97904.61, "maximum": 102799.84, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 102799.84, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 102799.84, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMYLASE, RANDOM URINE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 6.0, "minimum": 3.888, "maximum": 320.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.24 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.4 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA 1 ANTITRYPSIN PHENO", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.0, "discounted_cash": 14.0, "minimum": 8.676, "maximum": 151.0, "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.43, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.93 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.49 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.97 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG TOMATO", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 4", "code_information": [ { "code": "0074", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 212385.74, "maximum": 223005.03, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 223005.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 223005.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMYLOID STAIN", "code_information": [ { "code": "88313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 531.0, "discounted_cash": 141.0, "minimum": 40.49, "maximum": 693.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 170.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 156.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 134.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 191.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 229.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 292.82 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 79.06 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 96.78 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 95.75 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 95.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 93.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 156.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 313.67, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 177.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 95.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA FETOPROTEIN AMNIOTIC FL", "code_information": [ { "code": "82106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.0, "discounted_cash": 17.0, "minimum": 10.2, "maximum": 75.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 19.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.97 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.65 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG TUNA", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 26.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 1", "code_information": [ { "code": "0521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3823.11, "maximum": 4014.27, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4014.27, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4014.27, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAEROBIC CULTURE", "code_information": [ { "code": "87075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.0, "discounted_cash": 9.0, "minimum": 5.682, "maximum": 545.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 12.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.34, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.5 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 10.67 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.91 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 165.32 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 165.32 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 161.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 9.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.36, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 165.32 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.75, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA FETOPROTEIN TUMOR MARKER", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268.0, "discounted_cash": 16.0, "minimum": 10.062, "maximum": 268.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.47 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 18.76 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.97 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.06, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 150.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.32 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN,ANIMAL, FEATHER MIX", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.0, "discounted_cash": 7.0, "minimum": 4.782, "maximum": 34.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.69 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.27 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.78, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.56, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMIKACIN, TROUGH", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.0, "discounted_cash": 15.0, "minimum": 9.048, "maximum": 157.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% 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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.43, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.66 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.7 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.87 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 2", "code_information": [ { "code": "2262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7343.14, "maximum": 7710.3, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7710.3, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7710.3, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALPHA-FETOPROTEIN, BODY FLUID", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.0, "discounted_cash": 20.0, "minimum": 11.72, "maximum": 314.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 28.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.71, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.18 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 48.11 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.49, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 174.33 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 174.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 170.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.17 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 174.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN,HELMENTHOSPORIUM", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 757.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 1293.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMINO ACIDS PLASMA", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.0, "discounted_cash": 16.0, "minimum": 10.122, "maximum": 233.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 19.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.97 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.46 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 3", "code_information": [ { "code": "2263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10772.97, "maximum": 11311.62, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.62, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.62, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALT (SGPT)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.0, "discounted_cash": 5.0, "minimum": 3.18, "maximum": 296.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 63.93 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 63.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 62.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.69 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 63.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 3", "code_information": [ { "code": "8113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6114.23, "maximum": 6419.94, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6419.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6419.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMINO ACIDS QNT, URINE", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.0, "discounted_cash": 16.0, "minimum": 10.122, "maximum": 233.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 19.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.97 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.46 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8335.0, "minimum": 4321.4, "maximum": 19457.1935, "payers_information": [ { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8751.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7041.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12854.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8585.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10002.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8751.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9227.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9009.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9096.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7918.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10115.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10419.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12478.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11669.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 13503.07, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7491.71 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8418.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 12919.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 12854.77 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 12854.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 12584.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9168.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8751.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8751.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12502.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8585.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8585.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6774.0, "minimum": 4214.42, "maximum": 20017.4892, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8129.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7112.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7061.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6895.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6962.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6435.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7741.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8467.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9550.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9483.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10974.25, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5733.66 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6841.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 10500.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 7888.04 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 7888.04 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 7721.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7451.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7112.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7112.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10161.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6977.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6977.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7112.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4214.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6774.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7888.04 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6977.46, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 2", "code_information": [ { "code": "0522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4525.29, "maximum": 4751.55, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4751.55, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4751.55, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 93508.0, "minimum": 70159.2, "maximum": 172259.17, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 112210.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 98183.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 127374.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 124370.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 125575.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 88833.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 139639.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 116885.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 172259.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 130911.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 151483.82, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 103416.79 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 94443.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 144938.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 102859.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 98183.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 98183.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 140262.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 96313.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 96313.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 98183.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 93508.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 93508.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 112066.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 93508.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 93508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 96313.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMMONIA", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 14.0, "minimum": 8.742, "maximum": 255.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.93 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.49 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.88 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.88 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.13 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.88 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALUMINUM, UR", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.0, "discounted_cash": 25.0, "minimum": 12.54, "maximum": 227.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 35.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.25 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 28.69 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 59.06 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.64 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.64 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 164.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.95 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.64 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA 1 ANTITRYPSIN", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.0, "discounted_cash": 13.0, "minimum": 8.064, "maximum": 115.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% 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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.85 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 31.05 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.49 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPAR1 AB CBA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 282.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANG NSTA EC CAR VER ARC SI LT", "code_information": [ { "code": "36221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6485.0, "discounted_cash": 3367.0, "minimum": 202.68, "maximum": 6485.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.68 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6485.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPHETAMINE, SERUM", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 416.0, "discounted_cash": 114.0, "minimum": 46.431, "maximum": 798.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 416.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANG SCCI IPSI EXCR CAR WSI RT", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6485.0, "discounted_cash": 3367.0, "minimum": 232.0, "maximum": 9728.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 288.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 288.49 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6485.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMIKACIN, PEAK", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.0, "discounted_cash": 15.0, "minimum": 9.048, "maximum": 157.0, "payers_information": [ { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.87 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% 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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.43, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.66 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.7 } ] } ] }, { "description": "ALT, LIVER FIBROSIS", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.0, "discounted_cash": 5.0, "minimum": 3.18, "maximum": 296.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 63.93 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 63.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 62.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.69 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 63.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPHIPHYSIN AB IFA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 282.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANG SCCI IPSI INCR CAR WSI BIL", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18350.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 18350.0, "payers_information": [ { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6289.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.1 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13119.59, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "AMINOLEVULINIC ACID URINE", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.0, "discounted_cash": 16.0, "minimum": 9.87, "maximum": 132.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.11 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 18.39 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.37 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.87, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 4", "code_information": [ { "code": "0524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11504.66, "maximum": 12079.89, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12079.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12079.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANG SVA IPSI VERT W SI LT", "code_information": [ { "code": "36226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15480.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 23221.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2728.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6289.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 381.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 381.93 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13119.59, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPAR2 AB CBA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 282.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMINO ACID SINGLE QUANT", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.0, "discounted_cash": 16.0, "minimum": 10.122, "maximum": 233.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 19.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.97 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.46 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 1", "code_information": [ { "code": "1981", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3149.62, "maximum": 3307.1, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3307.1, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3307.1, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMIODARONE PANEL", "code_information": [ { "code": "80151", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 545.0, "discounted_cash": 18.0, "minimum": 11.184, "maximum": 545.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.2, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.64 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.03 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 4", "code_information": [ { "code": "1984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8633.17, "maximum": 9064.83, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9064.83, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9064.83, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIO DIALYSIS CIR W/STENT", "code_information": [ { "code": "36903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13725.0, "discounted_cash": 12310.0, "minimum": 306.52, "maximum": 13725.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13725.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13541.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6650.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12925.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13432.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11694.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13432.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 13725.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 13725.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13725.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13725.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13725.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13725.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13048.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13725.0 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13432.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13541.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12925.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13725.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12925.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13725.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12679.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13725.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12679.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12925.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.52 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 13424.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13432.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13725.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13725.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12679.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19071.0, "minimum": 14489.4, "maximum": 41411.89, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22885.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20024.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 24119.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 23550.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 23778.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18117.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26442.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23838.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 32618.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26699.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 30895.33, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 19582.92 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19261.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 29560.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 41411.89 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 41411.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 40540.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 20978.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20024.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20024.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28606.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19643.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19643.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 20024.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19071.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19071.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19950.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19071.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19071.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41411.89 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19643.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMITRIPTILINE & NORTRIPTYLINE", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.0, "discounted_cash": 114.0, "minimum": 46.431, "maximum": 798.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 1", "code_information": [ { "code": "3051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7011.39, "maximum": 7361.96, "payers_information": [ { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7361.96, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7361.96, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIO EXTREMITY UNIL S&I", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5898.0, "discounted_cash": 3367.0, "minimum": 71.16, "maximum": 5898.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.37 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 76.84 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 185.02 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2740.96 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2740.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2683.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.16 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2124.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5898.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2740.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10700.0, "minimum": 6355.0, "maximum": 17825.26, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12840.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11235.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12508.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12213.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12331.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10165.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13713.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13375.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16916.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14981.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 17335.28, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10155.89 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10807.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 16586.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 17825.26 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 17825.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 17449.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11770.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11235.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11235.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16051.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11021.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11021.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11235.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10700.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10700.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8209.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10700.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10700.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17825.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11021.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMMONIUM 24 HOUR URINE", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 14.0, "minimum": 8.742, "maximum": 255.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.93 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.49 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.88 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.88 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.13 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.88 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 4", "code_information": [ { "code": "3054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26286.99, "maximum": 27601.34, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 27601.34, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 27601.34, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 3", "code_information": [ { "code": "3053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14160.38, "maximum": 14868.4, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14868.4, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14868.4, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPHETAMINES, 1 OR 2", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.0, "discounted_cash": 114.0, "minimum": 46.431, "maximum": 798.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 372.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28329.0, "minimum": 16789.6831, "maximum": 86733.79, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 33995.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29745.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 36961.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 36090.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 36439.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26912.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 40521.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 35411.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 49986.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 39661.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 45893.69, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 30009.88 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 28612.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 43910.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 86733.79 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 86733.79 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 84907.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 31162.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29745.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 29745.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 42494.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 29179.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 29179.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 29745.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28329.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28329.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23427.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 28329.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 86733.79 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 29179.28, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGIOTENSIN CON ENZ, CSF", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.0, "discounted_cash": 14.0, "minimum": 8.76, "maximum": 187.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.3 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.55 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.1 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 136.47 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 136.47 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 133.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.17 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 136.47 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMYLASE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 6.0, "minimum": 3.888, "maximum": 320.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.24 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.4 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANA, IFA AUTOANTIBODIES", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.0, "discounted_cash": 11.0, "minimum": 6.696, "maximum": 170.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.31 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.57 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 154.32 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 154.32 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 151.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 154.32 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE 2 VIEW LEFT", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 456.0, "discounted_cash": 92.0, "minimum": 25.29, "maximum": 456.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 88.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 129.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 229.77 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 27.57 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 37.12 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 190.86 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 190.86 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 186.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.29 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.16, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 115.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 190.86 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMYLASE, 2 HR URINE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 6.0, "minimum": 3.888, "maximum": 320.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.24 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.4 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAPLASMA PHAGOCYTOPHILIUM IgG", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.0, "discounted_cash": 10.0, "minimum": 6.108, "maximum": 45.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.23 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.75 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE 2 VIEW RIGHT", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 456.0, "discounted_cash": 92.0, "minimum": 25.29, "maximum": 456.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 88.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 129.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 229.77 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 27.57 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 37.12 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 190.86 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 190.86 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 186.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.29 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.16, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 115.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 190.86 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANA, IFA W/RFLX MPLX BEAD", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.0, "discounted_cash": 11.0, "minimum": 6.696, "maximum": 170.0, "payers_information": [ { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.31 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.57 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 154.32 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 154.32 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 151.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 154.32 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23463.0, "minimum": 12427.7588, "maximum": 62744.67, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 28155.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 24636.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 30211.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 29499.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 29784.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22289.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 33120.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 29328.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 40857.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 32848.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 38010.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 24529.21 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 23697.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 36367.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 62744.67 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 62744.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 61423.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 25809.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 24636.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 24636.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 35194.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 24166.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 24166.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 24636.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23463.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23463.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19884.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 23463.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23463.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62744.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 24166.99, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANAPLASMA PHAGOCYTOPHILIUM IgM", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.0, "discounted_cash": 10.0, "minimum": 6.108, "maximum": 45.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.23 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.75 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29891 - ", "code_information": [ { "code": "29891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11617.0, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 11617.0, "payers_information": [ { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.83 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2684.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 11617.0, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 11617.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.83 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2684.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 1", "code_information": [ { "code": "2261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5549.66, "maximum": 5827.14, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5827.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5827.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39288.0, "minimum": 25588.9385, "maximum": 113070.76, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 47146.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41252.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 52163.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 50933.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 51426.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37324.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 57186.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 49110.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 70545.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 55003.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 63647.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 42352.36 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 39681.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 60897.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 113070.76 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 113070.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 110690.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 43217.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41252.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 41252.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 58932.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 40467.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 40467.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 41252.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 39288.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39288.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 39288.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39288.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 113070.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 40467.16, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29897 - ", "code_information": [ { "code": "29897", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16268.0, "discounted_cash": 3489.0, "minimum": 501.59, "maximum": 16268.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.59 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2684.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 16268.0, "discounted_cash": 3489.0, "minimum": 501.59, "maximum": 16268.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.59 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2684.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 2", "code_information": [ { "code": "3052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9349.49, "maximum": 9816.96, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9816.96, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9816.96, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANKLE LEFT W/WO CONTRAST", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5479.0, "discounted_cash": 372.0, "minimum": 290.6, "maximum": 8220.0, "payers_information": [ { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 446.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1582.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 353.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 520.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1200.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 500.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2070.0 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2626.77 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2626.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 427.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2571.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 558.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 290.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 290.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 510.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 822.54, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2626.77 } ] } ] }, { "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": 15973.0, "minimum": 11943.7358, "maximum": 39132.25, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 19168.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16772.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 19822.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 19355.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19542.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15175.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21731.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19967.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 26808.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 22363.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 25877.31, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 16094.36 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16133.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 24759.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 39132.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 39132.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 38308.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17571.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16772.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16772.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23960.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16452.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16452.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 16772.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15973.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15973.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14503.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15973.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15973.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39132.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16452.91, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANNA2 (RI) AB IFA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 282.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12520.0, "minimum": 9057.2638, "maximum": 36851.8862, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15024.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13146.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 15032.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14677.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14819.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11894.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16479.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15650.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 20329.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17528.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 20282.48, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 12204.8 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12645.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 19406.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 34299.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 34299.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 33577.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13772.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13146.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13146.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18780.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12895.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12895.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13146.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12520.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12520.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13187.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12520.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34299.66 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12895.6, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANDROSTENEDIONE", "code_information": [ { "code": "82154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.0, "discounted_cash": 28.0, "minimum": 13.44, "maximum": 126.0, "payers_information": [ { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.8 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "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": 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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.6, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 40.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.7, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.87 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 32.36 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 66.98 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2144.52, "maximum": 2251.74, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2251.74, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2251.74, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16705.0, "discounted_cash": 3489.0, "minimum": 174.19, "maximum": 16705.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2817.98 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 5988.7 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 5988.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2817.98 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 5862.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2817.98 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2817.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2682.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5988.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANG SCCI IPSI EXCR CAR SSI BIL", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9728.0, "discounted_cash": 3367.0, "minimum": 232.0, "maximum": 9728.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 288.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 288.49 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7444.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-CYCLIC CITRULLINE PEP AB", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.0, "discounted_cash": 12.0, "minimum": 7.77, "maximum": 153.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.48 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.78 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.54, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "ANG SCCI IPSI EXCR CAR WSI LT", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6485.0, "discounted_cash": 3367.0, "minimum": 232.0, "maximum": 9728.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 288.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 288.49 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6485.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amputation toe & metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13742.0, "discounted_cash": 3489.0, "minimum": 427.08, "maximum": 13742.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 5988.7 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 5988.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 5862.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 427.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 427.08 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6839.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5988.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANG SCCI IPSI INCR CAR WSI RT", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12232.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 18350.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6289.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.1 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12232.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-THROMB 3 AG", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.0, "discounted_cash": 10.0, "minimum": 4.51, "maximum": 207.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.95 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 12.14 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 24.96 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.49, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.97, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANG SCCI IPSI INCR CAR WSI LT", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12232.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 18350.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6289.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.1 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12232.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMYLASE, BODY FLUID", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 6.0, "minimum": 3.888, "maximum": 320.0, "payers_information": [ { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.4 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.24 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "115.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 2", "code_information": [ { "code": "1982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3763.66, "maximum": 3951.84, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3951.84, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3951.84, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTI-THROMBIN III ANTIGEN", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.0, "discounted_cash": 10.0, "minimum": 4.51, "maximum": 207.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.95 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 12.14 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 24.96 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.49, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.97, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANG SSI IPSI VERT W SI LT", "code_information": [ { "code": "36225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9728.0, "discounted_cash": 3367.0, "minimum": 232.0, "maximum": 14594.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.51 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7444.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANAEROBIC ID", "code_information": [ { "code": "87076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.0, "discounted_cash": 8.0, "minimum": 4.848, "maximum": 31.0, "payers_information": [ { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.88 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.0 } ] } ] }, { "description": "ANGIO EXTREMITY BIL S&I", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8709.0, "discounted_cash": 3367.0, "minimum": 74.93, "maximum": 8709.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.95 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 80.15 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 213.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2605.57 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2605.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2550.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.93 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2124.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7444.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2605.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY ID BASIC HBC", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 472.0, "discounted_cash": 382.0, "minimum": 37.0, "maximum": 472.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 458.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 420.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 363.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.27 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 45.97 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 71.24 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.67 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 439.56, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 210.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 420.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANG SVA IPSI VERT W SI RT", "code_information": [ { "code": "36226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15480.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 23221.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6289.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 381.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 381.93 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13119.59, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2728.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 4", "code_information": [ { "code": "2264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18008.02, "maximum": 18908.42, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 18908.42, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 18908.42, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIO SELECTIVE ADD VESSEL", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5600.0, "minimum": 52.39, "maximum": 5600.0, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5600.0 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 986.97 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 986.97 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5600.0 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 966.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5600.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5600.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.39 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 986.97 } ] } ] }, { "description": "ANTIBODY IDENTIFICATION", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 472.0, "discounted_cash": 382.0, "minimum": 37.0, "maximum": 472.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 458.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 420.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 363.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 173.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.27 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 45.97 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 71.24 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.67 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 439.56, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 173.28 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 210.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 420.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 173.28 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 173.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 3", "code_information": [ { "code": "1983", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4965.55, "maximum": 5213.83, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5213.83, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5213.83, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11683.0, "minimum": 7880.2, "maximum": 31804.1197, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14020.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12267.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 13871.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 13544.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13675.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11099.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15207.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14604.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 18759.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16356.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 18927.09, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 11262.53 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11800.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 18109.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 20943.86 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 20943.86 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 20502.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12851.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12267.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12267.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17525.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12033.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12033.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 12267.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11683.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11683.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12821.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11683.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11683.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20943.86 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12033.9, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY:HERPES SIMPLEX,TYPE1", "code_information": [ { "code": "86695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 13.0, "minimum": 7.914, "maximum": 204.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.48 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 30.44 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.91, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 105.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 105.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 103.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.13 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 105.41 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO ABDOMINAL", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8004.0, "discounted_cash": 3367.0, "minimum": 61.31, "maximum": 8004.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 554.64 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 66.56 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 141.83 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2466.48 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2466.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2414.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.31 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2124.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7444.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2466.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19223.0, "minimum": 7815.3762, "maximum": 54132.48, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23067.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20184.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 24330.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 23756.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 23986.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18262.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26673.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24029.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 32904.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26912.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 31141.65, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 19754.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19415.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 29795.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 54132.48 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 54132.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 52992.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 21145.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20184.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20184.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28834.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19799.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19799.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 20184.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19223.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19223.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 54132.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19799.9, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE COMPLETE LEFT, 3 VIEW", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 759.0, "discounted_cash": 92.0, "minimum": 29.75, "maximum": 759.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 463.75, "10th_percentile": 463.75, "90th_percentile": 463.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 88.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 129.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 263.49 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 31.62 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.33 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 211.05 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 211.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 206.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.16, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 115.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 211.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY:MUMPS", "code_information": [ { "code": "86735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.0, "discounted_cash": 13.0, "minimum": 7.83, "maximum": 157.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.48 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 30.44 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 96.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.66, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.41 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO DIALYSIS CIRCUIT W/PTA", "code_information": [ { "code": "36902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8451.0, "discounted_cash": 6069.0, "minimum": 230.53, "maximum": 8451.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7283.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6676.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6650.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6372.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4626.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5765.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4626.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8193.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8451.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8451.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4857.98 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8451.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6979.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6433.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4857.98 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4626.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6676.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6372.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4857.98 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6372.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8451.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6251.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4857.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6251.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6372.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 230.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 230.53 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4623.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4626.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8451.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7586.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6251.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANNA1 (HU) AB IFA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 282.0, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY:RUBEOLA", "code_information": [ { "code": "86765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.0, "discounted_cash": 12.0, "minimum": 7.728, "maximum": 155.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 88.77 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 88.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 88.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO VISCERAL SEL W/WO ABAO", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9535.0, "discounted_cash": 5933.0, "minimum": 79.39, "maximum": 9535.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9535.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 720.06 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 86.41 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 161.92 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2392.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2392.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6289.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2342.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.39 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9535.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2392.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANG NSTA EC CAR VER ARC SI RT", "code_information": [ { "code": "36221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6485.0, "discounted_cash": 3367.0, "minimum": 202.68, "maximum": 6485.0, "payers_information": [ { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.68 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6485.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "ANNA3 AB IFA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 282.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTICOAGULANT POISONING PANEL", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 397.0, "discounted_cash": 114.0, "minimum": 46.431, "maximum": 798.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGIOGRAM FOLLOW UP/RE-CHECK", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1663.0, "discounted_cash": 3367.0, "minimum": 51.05, "maximum": 1663.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1348.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1348.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1416.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 425.42 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 51.05 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 75.31 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1145.94 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1145.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1416.28 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1121.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1348.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1416.28 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1416.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.67 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1348.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1348.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1145.94 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1663.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANG SIC IPSI INCRAN CAR WSI BI", "code_information": [ { "code": "36224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21278.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 21278.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2728.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6289.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 385.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 385.67 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13119.59, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 4", "code_information": [ { "code": "0594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11090.17, "maximum": 11644.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11644.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11644.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7166.04, "maximum": 7524.34, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.34, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.34, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIOP TRLUML BALO ADDL VEIN", "code_information": [ { "code": "37249", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 796.0, "minimum": 143.22, "maximum": 796.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 796.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 796.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 796.0 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 796.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 796.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 796.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 796.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 796.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 796.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.22 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 796.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 796.0 } ] } ] }, { "description": "ANG SSI IPSI VERT W SI BIL", "code_information": [ { "code": "36225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14594.0, "discounted_cash": 3367.0, "minimum": 232.0, "maximum": 14594.0, "payers_information": [ { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.51 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7444.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5473", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11911.92, "maximum": 12507.52, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12507.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12507.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10535.58, "maximum": 11062.36, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11062.36, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11062.36, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANG SSI IPSI VERT W SI RT", "code_information": [ { "code": "36225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9728.0, "discounted_cash": 3367.0, "minimum": 232.0, "maximum": 14594.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.51 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7444.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23239.83, "maximum": 24401.82, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24401.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24401.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10429.0, "minimum": 4829.8, "maximum": 16895.871, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12515.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10950.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12132.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11846.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11960.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9908.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13300.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13036.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16407.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14601.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 16895.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9850.41 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10533.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 16165.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11472.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10950.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15644.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10742.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10742.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10429.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10429.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16050.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10429.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10429.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10742.39, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29898 - ", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11617.0, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 11617.0, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 563.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 563.69 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2684.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 } ] }, { "setting": "outpatient", "gross_charge": 11617.0, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 11617.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 563.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 563.69 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2684.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANG SVA IPSI VERT W SI BIL", "code_information": [ { "code": "36226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23221.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 23221.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2728.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6289.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 381.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 381.93 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13119.59, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-HU WESTERN BLOT", "code_information": [ { "code": "84181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.0, "discounted_cash": 17.0, "minimum": 10.218, "maximum": 60.0, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.69 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 22.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 19.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 39.58 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPL UNIPLN UNI EXT FIXJ SYS", "code_information": [ { "code": "20690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15255.3, "discounted_cash": 7737.0, "minimum": 488.0, "maximum": 15255.33, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9285.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8511.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10446.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10832.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12535.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 7367.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 7367.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8898.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8202.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 7212.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8511.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11606.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.84 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2905.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15255.33, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9672.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7367.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 15255.33, "discounted_cash": 7737.0, "minimum": 488.0, "maximum": 15255.33, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9285.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8511.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2389.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10446.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10832.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12535.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 7367.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 7367.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8898.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8202.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 7212.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8511.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11606.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.84 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2905.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15255.33, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9672.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7367.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE COMPLETE RIGHT, 3 VIEW", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 759.0, "discounted_cash": 92.0, "minimum": 29.75, "maximum": 759.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 463.75, "10th_percentile": 463.75, "90th_percentile": 463.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 88.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 129.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 263.49 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 31.62 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.33 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 211.05 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 211.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 206.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.16, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 115.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 211.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7046.0, "minimum": 4482.3334, "maximum": 26613.4076, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8455.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7398.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7439.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7263.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7334.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6693.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8155.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8807.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10060.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9864.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11414.91, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6040.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7116.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 10921.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 11502.94 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 11502.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 11260.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7750.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9000.0, "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": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7398.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7398.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10569.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7257.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7257.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7398.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6299.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7046.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11502.94 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7257.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-NEUTROPHIL CYTO AB, IGG", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.0, "discounted_cash": 11.0, "minimum": 6.918, "maximum": 375.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 119.15, "10th_percentile": 119.15, "90th_percentile": 119.15, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.67 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 26.79 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.22 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.22 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.22 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE LEFT W/O CONTRAST", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4540.0, "discounted_cash": 254.0, "minimum": 145.94, "maximum": 6811.0, "payers_information": [ { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1893.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 279.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1362.0, "10th_percentile": 1362.0, "90th_percentile": 1362.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.94 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 302.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 562.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1934.3 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 305.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 279.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1582.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 241.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 343.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 356.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 412.19, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1200.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 500.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2070.0 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1934.3 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1934.3 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 292.61, "additional_payer_notes": "115.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO DIALYSIS CIRCUIT", "code_information": [ { "code": "36901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1549.0, "discounted_cash": 1678.0, "minimum": 161.77, "maximum": 1549.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1549.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1549.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1549.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1549.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1549.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1549.0 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1549.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1549.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1549.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.77 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1549.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1549.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1549.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY:LYMPHOCYTC CHRMIMENNG", "code_information": [ { "code": "86727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 12.0, "minimum": 7.722, "maximum": 255.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.66 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENTESIS SM JNT BILAT", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 684.0, "discounted_cash": 327.0, "minimum": 33.81, "maximum": 684.0, "payers_information": [ { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 662.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 662.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 376.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 324.6 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 649.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 360.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 324.6 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 324.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.81 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 308.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 684.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 409.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 662.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 360.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 684.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 310.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 441.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 458.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 530.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 324.6 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 684.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE RIGHT W/O CONTRAST", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4540.0, "discounted_cash": 254.0, "minimum": 145.94, "maximum": 6811.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 305.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 279.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1582.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 241.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 343.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 356.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 412.19, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1200.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 500.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2070.0 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1934.3 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1934.3 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 292.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1893.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 279.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1362.0, "10th_percentile": 1362.0, "90th_percentile": 1362.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.94 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 302.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 562.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1934.3 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO PELVIC SELECTIVE", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5692.0, "discounted_cash": 5933.0, "minimum": 96.45, "maximum": 5692.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5692.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 857.89 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 102.95 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 181.97 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1806.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1806.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5692.0 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 1768.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5692.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5692.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.45 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1806.11 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5692.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY:VARICELLA-ZOSTER", "code_information": [ { "code": "86787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161.0, "discounted_cash": 12.0, "minimum": 7.728, "maximum": 161.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.12 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 107.77 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 107.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 105.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 107.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM HIP LEFT", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2131.0, "discounted_cash": 372.0, "minimum": 107.96, "maximum": 2131.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 446.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 353.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 520.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 931.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 111.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 124.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 427.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.05 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.05 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 558.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.96 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 822.54, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE RIGHT W/WO CONTRAST", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5479.0, "discounted_cash": 372.0, "minimum": 290.6, "maximum": 8220.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 446.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1582.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 353.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 520.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1200.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 500.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2070.0 }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2626.77 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2626.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 427.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 2571.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 927.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 558.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 290.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 290.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 510.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 822.54, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2626.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO PULMONARY UNILAT SEL", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5377.0, "discounted_cash": 3367.0, "minimum": 71.85, "maximum": 5377.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5377.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 655.7 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 78.68 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 150.97 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.85 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2124.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5377.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIGEN IDENTIFICATION", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 358.0, "discounted_cash": 382.0, "minimum": 4.0, "maximum": 358.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.35 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 4.41 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.14 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.02 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.02 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.55 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.02 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM SHOULDER RIGHT", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4382.0, "discounted_cash": 372.0, "minimum": 111.05, "maximum": 4382.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 446.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 353.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 520.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 971.45 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 116.57 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 124.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 658.77 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 658.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 427.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 644.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 558.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.05 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 822.54, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 658.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 2", "code_information": [ { "code": "0592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5680.2, "maximum": 5964.21, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5964.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5964.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIOTENSION CONVERTING ENZYME", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.0, "discounted_cash": 14.0, "minimum": 8.76, "maximum": 187.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.3 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.55 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.1 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 136.47 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 136.47 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 133.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.17 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 136.47 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTINUCLEAR AB - QNT IFA", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.0, "discounted_cash": 11.0, "minimum": 6.696, "maximum": 170.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.31 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.57 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 154.32 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 154.32 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 151.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 154.32 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM WRIST LEFT", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1267.0, "discounted_cash": 372.0, "minimum": 109.33, "maximum": 1267.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 446.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 353.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 520.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 999.03 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 119.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 133.91 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 427.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.05 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 409.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.05 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 558.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.33 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 822.54, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 465.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 3", "code_information": [ { "code": "0593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8012.48, "maximum": 8413.1, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8413.1, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8413.1, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Ankle arthroscopy/surgery", "code_information": [ { "code": "29895", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48804.0, "discounted_cash": 3489.0, "minimum": 465.24, "maximum": 48804.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.24 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2684.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTINUCLEAR ANTIBODIES", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.0, "discounted_cash": 17.0, "minimum": 10.758, "maximum": 429.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.05, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.92 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 20.23 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 41.39 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.52 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 111.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8130.42, "maximum": 8536.94, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8536.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8536.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 1", "code_information": [ { "code": "0591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3458.51, "maximum": 3631.44, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3631.44, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3631.44, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AORTA", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1427.0, "discounted_cash": 111.0, "minimum": 34.89, "maximum": 1427.0, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.12 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.89 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.48, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 556.32 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 133.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 105.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 156.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 180.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 303.33 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 36.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 50.5 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 556.32 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 556.32 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.12 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 544.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY NONENDOCRINE RECPTOR", "code_information": [ { "code": "84238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "discounted_cash": 36.0, "minimum": 21.942, "maximum": 177.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 34.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 49.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 51.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.56 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 41.19 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.94, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 177.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 177.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.06, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.11 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 177.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.03 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.88, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 177.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3056.34, "maximum": 3209.16, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3209.16, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3209.16, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5489.52, "maximum": 5763.99, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5763.99, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5763.99, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AORTAGRAM ABD W/BILAT FEM RUN", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5946.0, "discounted_cash": 3367.0, "minimum": 66.7, "maximum": 5946.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.53 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 72.06 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 141.83 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 3801.52 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 3801.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3569.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 3721.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2232.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.7 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2124.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2125.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3801.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF TRIGLYCERIDES", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.0, "discounted_cash": 5.0, "minimum": 3.444, "maximum": 170.0, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.52 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 6.62 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.4 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.44, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.14 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.14 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "A Indicator - 110.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.14 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4384.69, "maximum": 4603.93, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4603.93, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4603.93, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10624.68, "maximum": 11155.91, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11155.91, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11155.91, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AORTAGRAM THORACIC", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5946.0, "discounted_cash": 5933.0, "minimum": 71.16, "maximum": 5946.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 634.24 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 76.11 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 142.44 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5828.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.16 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5547.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5550.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5946.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AST (SGOT)", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 261.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.64 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.64 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.64 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 60.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-HU TITER", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 195.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-STREPTOLYSIS O, QUANT", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.0, "discounted_cash": 7.0, "minimum": 4.38, "maximum": 212.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.97 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.09 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.05 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.75 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 96.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.59 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APHER PLTS-BACT IRR LEUK REDUC", "code_information": [ { "code": "P9073", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2562.0, "discounted_cash": 604.0, "minimum": 346.84, "maximum": 2562.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 725.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 664.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 574.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 816.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 846.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 979.21, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 936.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 695.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 640.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 664.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 906.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 622.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 622.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1336.44, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 755.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.58, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AST, LIVER FIBROSIS", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 261.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.64 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.64 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 60.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.64 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-MULLERIAN HORMONE", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 17.0, "minimum": 10.362, "maximum": 328.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.19 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 19.49 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 157.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 157.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 154.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.04 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "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": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 157.8 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-THROMBIN III ACTIVITY", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 519.0, "discounted_cash": 11.0, "minimum": 4.51, "maximum": 519.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.04 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 27.41 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.84 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.84 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 225.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.18 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" } ] } ] }, { "description": "APP BODY INJTR TIMED SUBQ INJ", "code_information": [ { "code": "96377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 49.0, "minimum": 19.69, "maximum": 255.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 255.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 47.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 67.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.08 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.08 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 54.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.69 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.37, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 3", "code_information": [ { "code": "1413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4577.25, "maximum": 4806.11, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4806.11, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4806.11, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTI-NUCLEAR ANTIBODY SCREEN", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.0, "discounted_cash": 12.0, "minimum": 7.254, "maximum": 186.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.4 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 114.52 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 114.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 112.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.53 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 114.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY ID COMPLEX HBC", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 472.0, "discounted_cash": 382.0, "minimum": 37.0, "maximum": 472.0, "payers_information": [ { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 458.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 420.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 363.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.27 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 45.97 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 71.24 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.67 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 439.56, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 210.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 420.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2332", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8835.64, "maximum": 9277.42, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9277.42, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9277.42, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTIDIURETIC HORMONE", "code_information": [ { "code": "84588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 33.0, "minimum": 20.364, "maximum": 125.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 40.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 32.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 45.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 38.25 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 78.55 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 37.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.21 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.73, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY SCREEN", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.0, "discounted_cash": 55.0, "minimum": 4.51, "maximum": 245.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 66.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 75.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 77.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.86 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.14 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.2 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.2 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 97.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 57.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 57.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.87, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.2 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.24, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17943.17, "maximum": 18840.33, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 18840.33, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 18840.33, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6826.0, "minimum": 4299.0552, "maximum": 20111.9354, "payers_information": [ { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 18032.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7509.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7168.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7168.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10240.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7031.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7031.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7168.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4971.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18420.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7031.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8192.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7168.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7135.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6966.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7034.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6485.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7822.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8533.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9649.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9557.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11059.66, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5793.04 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6895.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 10581.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 18420.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 18420.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6826.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIGEN ID CHARGE", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 358.0, "discounted_cash": 382.0, "minimum": 4.51, "maximum": 358.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 6.99 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.14 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.21 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY TITER", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.0, "discounted_cash": 181.0, "minimum": 4.51, "maximum": 195.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 195.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 195.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 195.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 195.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 195.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 141.45 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 141.45 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 138.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 195.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 195.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 195.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 141.45 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% 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": 33951.0, "minimum": 6544.43, "maximum": 67341.4169, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 40741.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35649.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 44760.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 43705.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 44128.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 32253.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 49070.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 42439.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 60533.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 47532.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 55001.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 36341.61 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 34291.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 52624.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 37346.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35649.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 35649.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 50927.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 34970.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 34970.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 35649.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33951.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33951.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6544.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 33951.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 34970.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY:HERPES SIMPLEX,TYPE2", "code_information": [ { "code": "86696", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 19.0, "minimum": 11.61, "maximum": 252.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 26.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.37 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 21.7 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 45.06 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.9 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.9 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.06 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 19.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.9 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.93, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APHERESIS PLTS-BACT LEUK REDUC", "code_information": [ { "code": "P9073", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2562.0, "discounted_cash": 604.0, "minimum": 346.84, "maximum": 2562.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 725.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 664.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 346.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 574.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 346.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 816.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 846.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 979.21, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.18 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 936.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 695.12, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 640.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.18 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 346.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 664.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.18 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 906.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 622.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 622.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 346.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1336.44, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 755.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.58, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTINUCLEAR ANTIGEN ABS X10", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.0, "discounted_cash": 17.0, "minimum": 10.758, "maximum": 429.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.05, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.92 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 20.23 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 41.39 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.52 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 111.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL COMPLETE LOWER", "code_information": [ { "code": "93923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2317.0, "discounted_cash": 230.0, "minimum": 116.0, "maximum": 2317.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 276.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 253.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 218.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 310.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.01, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 218.55 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1011.13 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 273.01 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 202.07 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 264.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 218.55 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 253.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 218.55 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 345.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 237.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 218.55 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 237.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 287.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.16, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTO DIFF WBC COUNT", "code_information": [ { "code": "85004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.0, "discounted_cash": 6.0, "minimum": 3.882, "maximum": 59.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.24 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.88, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.31 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.31 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.34 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.34 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.31 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APOLIPOPROTEIN B", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.0, "discounted_cash": 21.0, "minimum": 12.17, "maximum": 132.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.18 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 35.92 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.25, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.58 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.36, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "ANTITHROMBIN, ENZYMATIC", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 441.0, "discounted_cash": 11.0, "minimum": 4.51, "maximum": 519.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.04 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 27.41 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.84 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.84 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 225.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.18 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL LINE INSERTION", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 570.0, "minimum": 43.19, "maximum": 570.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 570.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 570.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 570.0 }, { "payer_name": "Beacon (fka Value Options)", "plan_name": "Beacon (fka Value Options) Commercial Non HMO Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 408.0 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 570.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 570.0 }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 570.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 570.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 570.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 570.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 570.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.19 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 570.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 570.0 } ] } ] }, { "description": "AUTO PROCESSING CHARGE", "code_information": [ { "code": "86890", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 378.0, "discounted_cash": 181.0, "minimum": 81.0, "maximum": 549.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 254.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.73 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 378.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 105.18 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 163.79 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 281.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 378.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 378.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.73 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 378.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.73 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 378.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 378.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2331", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6841.35, "maximum": 7183.42, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7183.42, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7183.42, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54235.0, "minimum": 14397.0, "maximum": 98584.72, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 55862.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 55862.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 56947.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 54235.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54235.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14397.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 54235.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 55862.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 65082.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 56947.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 72896.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 71178.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 71867.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51523.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 79916.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 67794.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 98584.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 75929.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 87861.14, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 59185.91 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 54777.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 84064.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 59658.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 54235.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 56947.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 56947.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 81352.91, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ASPERGILLUS FAMIGATUS ANTIBODY", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.0, "discounted_cash": 15.0, "minimum": 9.03, "maximum": 214.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.66 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.7 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTO WASHED PACKED CELLS CHG", "code_information": [ { "code": "86890", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 476.0, "discounted_cash": 181.0, "minimum": 81.0, "maximum": 549.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 254.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 389.57 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 105.18 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 163.79 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 281.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 401.69, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 476.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12803.84, "maximum": 13444.03, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13444.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13444.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APOLIPOPROTEIN A1", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.0, "discounted_cash": 21.0, "minimum": 12.17, "maximum": 132.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.18 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 35.92 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.25, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.58 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ASPERGILLUS FLAVUS ANTIBODY", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.0, "discounted_cash": 15.0, "minimum": 9.03, "maximum": 214.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.66 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.7 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 1", "code_information": [ { "code": "0081", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 42534.69, "maximum": 44661.42, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 44661.42, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 44661.42, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19981.0, "minimum": 12964.2, "maximum": 34327.42, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23978.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20981.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 25382.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 24784.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 25024.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18982.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 27827.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24977.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 34327.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 27974.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 32370.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 20608.67 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 20181.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 30972.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 21980.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20981.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20981.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29972.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20581.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 20581.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 20981.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19981.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19981.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27751.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19981.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19982.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20581.46, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Appendectomy", "code_information": [ { "code": "44950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22024.0, "discounted_cash": 6903.0, "minimum": 679.95, "maximum": 22024.0, "payers_information": [ { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7110.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8284.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7593.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3368.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7248.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4793.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6558.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4793.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 9319.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9664.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11183.62, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5032.97 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10700.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7938.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7317.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5032.97 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4793.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7593.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7248.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5032.97 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7248.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10355.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7110.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5032.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7110.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7248.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 679.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 679.95 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4790.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4793.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15263.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8629.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF PROTEIN OTHER", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.0, "discounted_cash": 4.0, "minimum": 2.4, "maximum": 123.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.35 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 4.41 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.4, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.21 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.21 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 59.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.8 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.21 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.12, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTOTRANSPLANT PARATHYROID", "code_information": [ { "code": "60512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26637.17, "minimum": 236.54, "maximum": 26637.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2728.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5423.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5423.4 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5694.57 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5694.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5423.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5694.57 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5694.57 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.54 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5420.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5423.4 } ] }, { "setting": "outpatient", "gross_charge": 26637.2, "minimum": 236.54, "maximum": 26637.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2728.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5423.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5423.4 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5694.57 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5694.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5423.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5694.57 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5694.57 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.54 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5420.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5423.4 } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2334", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19153.79, "maximum": 20111.48, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20111.48, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 20111.48, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ASSAY OF PROTEIN URINE - 84156 - 30119200", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326.0, "discounted_cash": 3.0, "minimum": 2.202, "maximum": 326.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.95, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.98 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 4.04 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.2, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.09 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.22, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 68.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "B PERTUSSIS AB IgG (IMMBLOT)", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.0, "discounted_cash": 13.0, "minimum": 7.914, "maximum": 152.0, "payers_information": [ { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.13 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.48 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 30.44 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.91, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "ARRYTHMIA INDUCTION", "code_information": [ { "code": "93618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12572.0, "discounted_cash": 1298.0, "minimum": 232.0, "maximum": 12572.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1558.01, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1428.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6650.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1363.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8000.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1233.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8000.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1752.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1817.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2103.31, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8400.53 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2012.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9659.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1493.09, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1376.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8400.53 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8000.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1428.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1363.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8400.53 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1363.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1947.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1337.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8400.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1337.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1363.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 621.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 7995.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8000.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2870.63, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1622.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1298.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1337.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5548.0, "maximum": 5825.4, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5825.4, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5825.4, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ASTHMA - SOI : 2", "code_information": [ { "code": "1412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3806.06, "maximum": 3996.36, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3806.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3806.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3996.36, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3806.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3806.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3996.36, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3806.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "B-HYDROXYBUTYRATE", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.0, "discounted_cash": 8.0, "minimum": 4.902, "maximum": 166.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.05 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.88 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 76.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 76.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 74.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 76.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARSENIC URINE", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.0, "discounted_cash": 18.0, "minimum": 11.382, "maximum": 121.0, "payers_information": [ { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 21.33 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 43.84 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 25.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "162.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13248.0, "minimum": 7626.0, "maximum": 24953.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15897.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13910.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 16042.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 15663.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 15815.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12585.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17586.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16560.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 21695.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 18547.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 21462.1, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 13024.88 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13380.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 20534.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14573.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13910.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13910.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19872.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13645.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13645.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13910.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13248.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13248.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24953.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13248.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13248.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13645.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ATHER/PTCA MAJ ART OR BRAN EA", "code_information": [ { "code": "92925", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15797.0, "minimum": 3159.4, "maximum": 15797.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15797.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10297.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10297.95 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10812.85 }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8321.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10812.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10297.95 }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 9399.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10812.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10812.85 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 10291.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10297.95 } ] } ] }, { "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": 30238.0, "minimum": 13726.8, "maximum": 53568.78, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 36286.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31750.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 39610.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 38676.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 39051.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28726.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 43424.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 37798.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 53568.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 42334.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 48986.95, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 32160.33 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 30541.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 46870.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 33262.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31750.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 31750.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 45358.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 31146.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 31146.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 31750.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 30238.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30238.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31441.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 30238.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 30238.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 31146.07, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL BLOOD GASES", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 453.0, "discounted_cash": 78.0, "minimum": 37.0, "maximum": 453.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 94.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 86.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 74.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 106.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 110.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 127.61, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 328.27 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 88.63 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 65.75 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.26, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 219.04 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 219.04 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 86.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.22 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 81.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 81.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.52, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 219.04 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Appl mltpln uni ext fixj sys", "code_information": [ { "code": "20692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25549.0, "discounted_cash": 13690.0, "minimum": 558.0, "maximum": 25549.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16428.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15059.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2728.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14375.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13006.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 18482.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19167.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22179.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21220.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 7367.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 7367.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15744.36, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14512.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 7212.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15059.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14375.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14375.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20536.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14101.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 14101.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14375.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1137.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1137.7 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2905.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25549.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17113.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7367.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14101.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ATHER/STENT/PTCA MAJ ART OR BR", "code_information": [ { "code": "92933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31204.0, "discounted_cash": 19548.0, "minimum": 628.55, "maximum": 31204.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 23457.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21503.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18000.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20525.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10297.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18570.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10297.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 26390.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 27367.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31204.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10812.85 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30299.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Community Partners Health Plan", "plan_name": "Community Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8321.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22480.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20721.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10812.85 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10297.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 21503.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 6206.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20525.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10812.85 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20525.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29322.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 20134.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10812.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 20134.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20525.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 628.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 628.55 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 10291.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10297.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31204.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24435.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19548.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20134.71, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 1", "code_information": [ { "code": "0491", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6215.67, "maximum": 6526.45, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6526.45, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6526.45, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARTERIAL COMPLETE UPPER", "code_information": [ { "code": "93923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2317.0, "discounted_cash": 230.0, "minimum": 116.0, "maximum": 2317.0, "payers_information": [ { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 264.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 218.55 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 253.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 345.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 237.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 237.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 287.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 276.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 253.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 218.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 310.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.01, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1011.13 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 273.01 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 202.07 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.89, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "APT FETAL HEMOGLOBIN", "code_information": [ { "code": "83033", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.0, "discounted_cash": 8.0, "minimum": 4.8, "maximum": 123.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.69 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.6 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 4", "code_information": [ { "code": "0494", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22989.79, "maximum": 24139.28, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24139.28, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24139.28, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARTHRO ELBOW LEFT INJ", "code_information": [ { "code": "24220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 575.0, "minimum": 60.01, "maximum": 575.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 575.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 575.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 } ] } ] }, { "description": "AUTO DEGLY PACKED CELLS", "code_information": [ { "code": "P9039", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1076.0, "discounted_cash": 311.0, "minimum": 157.28, "maximum": 1076.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 373.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 342.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 327.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 295.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 420.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 436.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 504.58, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 482.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 330.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 342.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 327.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 467.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 320.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 320.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 688.66, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 389.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21390.0, "minimum": 13981.0, "maximum": 54166.77, "payers_information": [ { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 22194.61 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 21604.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 33154.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 54166.77 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 54166.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 53026.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 23529.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22459.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 22459.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 32085.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22031.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 22031.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 22459.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21390.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21390.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24302.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21390.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 54166.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22031.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 25668.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22459.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 27336.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 26691.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 26950.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20320.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 29968.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 26737.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 36969.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 29946.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 34652.04, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 21390.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ARTHRO ELBOW RT INJ", "code_information": [ { "code": "24220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 575.0, "minimum": 60.01, "maximum": 575.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 575.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 575.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.01 } ] } ] }, { "description": "AUTO WASHED PACKED CELLS", "code_information": [ { "code": "P9022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 614.0, "discounted_cash": 366.0, "minimum": 122.8, "maximum": 614.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 440.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 403.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 385.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 346.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 348.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 346.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 495.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 513.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 594.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.18 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 568.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 421.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 388.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.18 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 346.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 403.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 385.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.18 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 385.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 550.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 377.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 377.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 385.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 346.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 614.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 458.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.77, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL IDENTIFICATION", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.0, "discounted_cash": 8.0, "minimum": 4.848, "maximum": 123.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 61.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 75.15, "10th_percentile": 75.15, "90th_percentile": 75.15, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 100.86, "10th_percentile": 100.86, "90th_percentile": 100.86, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.88 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.01 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.01 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 63.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.01 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHRO HIP RT INJW/O ANE", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1215.0, "minimum": 62.23, "maximum": 1215.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1215.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1215.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 } ] } ] }, { "description": "AUTO WHOLE BLOOD CHARGE", "code_information": [ { "code": "86890", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 449.0, "discounted_cash": 181.0, "minimum": 81.0, "maximum": 549.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 254.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 389.57 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 105.18 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 163.79 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 281.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 449.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 449.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "fee schedule", "standard_charge_dollar": 449.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 401.69, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 449.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ARTHRO HIPLT INJ W/O ANE", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1215.0, "minimum": 62.23, "maximum": 1215.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1215.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1215.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.23 } ] } ] }, { "description": "ARSENIC UR FRACT", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.0, "discounted_cash": 18.0, "minimum": 11.382, "maximum": 121.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 25.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 21.33 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 43.84 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 2", "code_information": [ { "code": "0082", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 56602.4, "maximum": 59432.52, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 56602.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 56602.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 59432.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 56602.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 56602.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 59432.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 56602.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARTHRO KNEE LEFT INJ", "code_information": [ { "code": "27369", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 344.0, "minimum": 36.48, "maximum": 344.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 344.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 344.0 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 344.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 344.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 344.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 344.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 344.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 344.0 } ] } ] }, { "description": "ARSENIC, BLOOD", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.0, "discounted_cash": 18.0, "minimum": 11.382, "maximum": 121.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 25.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 21.33 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 43.84 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "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", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 3", "code_information": [ { "code": "0083", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 67651.64, "maximum": 71034.22, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 67651.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 67651.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 71034.22, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 67651.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 67651.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 71034.22, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 67651.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARTHRO SHOULDER LT INJ", "code_information": [ { "code": "23350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1988.0, "minimum": 44.81, "maximum": 1988.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1775.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1988.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 } ] } ] }, { "description": "ARTERIAL EVAL/TREAD LOW EXTREM", "code_information": [ { "code": "93924", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1046.0, "discounted_cash": 230.0, "minimum": 137.26, "maximum": 1046.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 276.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 253.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 218.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 310.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.01, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1046.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 341.69 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 258.69 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 264.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.12 }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 253.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.12 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 345.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 237.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 237.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 287.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.16, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43189.0, "minimum": 34690.6678, "maximum": 77864.14, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 51827.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45349.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 57575.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 56217.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 56762.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41030.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 63119.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 53987.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 77864.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 60465.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 69967.57, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 46746.19 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 43621.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "case rate", "standard_charge_dollar": 66944.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 47508.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45349.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 45349.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 64784.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "case rate", "standard_charge_dollar": 44485.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 44485.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 45349.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 43189.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43189.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 63925.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 43189.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43189.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 44485.6, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHRO SHOULDER RT INJ", "code_information": [ { "code": "23350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1988.0, "minimum": 44.81, "maximum": 1988.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1775.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1988.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.81 } ] } ] }, { "description": "ARTERIAL LINE", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 570.0, "minimum": 43.19, "maximum": 570.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 570.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 570.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.19 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 570.0 } ] } ] }, { "description": "ARTHRO WRIST LEFT INJ", "code_information": [ { "code": "25246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1785.0, "minimum": 65.66, "maximum": 1785.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1775.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "Cenpatico Medicaid", "plan_name": "Cenpatico Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1785.0 }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 431.89 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.66 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.32 } ] } ] }, { "description": "ARTHRO KNEE RIGHT INJ", "code_information": [ { "code": "27369", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 344.0, "minimum": 36.48, "maximum": 344.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 344.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.48 } ] } ] }, { "description": "B CELLS TOTAL COUNT", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.0, "discounted_cash": 37.0, "minimum": 22.638, "maximum": 170.0, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 38.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 38.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "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": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 35.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.12, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.64 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 42.29 }, { "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 87.67 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.71 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.6, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENTESIS MED JNT BILAT", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 592.0, "discounted_cash": 327.0, "minimum": 34.48, "maximum": 592.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 360.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Advocate Helath Partners", "plan_name": "Advocate Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 592.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 310.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 441.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 458.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 530.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 592.0 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "CIGNA HEALTHSPRING", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Medicare", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Work Comp", "methodology": "case rate", "standard_charge_dollar": 592.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 592.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 376.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harmony Health Plan", "plan_name": "Harmony Health Plan AKA Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare Non Contrcated (1/1/2026-12/31/2026)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 592.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 360.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.48 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 308.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 592.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 409.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC VA CCN", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 592.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHRO WRIST RIGHT INJ", "code_information": [ { "code": "25246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1785.0, "minimum": 65.66, "maximum": 1785.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate