{ "hospital_name": "St. Mary's Hospital - Kankakee", "last_updated_on": "2026-09-01", "version": "3.0", "location_name": [ "St. Mary's Hospital - Kankakee" ], "hospital_address": [ "500 W. Court St., Kankakee, Illinois 60901" ], "license_information": { "license_number": "0006505", "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": "Patrick Kerrwood" }, "type_2_npi": [ "1467290809", "1407645724" ], "standard_charge_information": [ { "description": "*11ADDL NECK SPINE FUSION", "code_information": [ { "code": "22552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7515.18, "minimum": 386.35, "maximum": 7515.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1169.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7515.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7515.18 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7515.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7515.18 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7515.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7515.18 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 386.35, "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": 386.35 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 7515.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7515.18 } ] } ] }, { "description": "*CRYPTOSPROIDIUM EIA", "code_information": [ { "code": "87328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.0, "discounted_cash": 13.0, "minimum": 7.41, "maximum": 69.3, "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": "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": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.84 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 7.78 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 7.41 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 69.3 }, { "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": "*ALPHA FETOPROTEIN MATERNAL", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.0, "discounted_cash": 16.0, "minimum": 8.41, "maximum": 186.4, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 145.03 }, { "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": "*ALBUMIN FOR TESTOSTERONE", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 4.0, "minimum": 2.97, "maximum": 155.04, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.5735, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 108.15, "10th_percentile": 108.15, "90th_percentile": 108.15, "count": "1 through 10" }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.29 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.29 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 155.04 }, { "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": "*COXSACKIE A, 16 ANTIBODY", "code_information": [ { "code": "86658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.0, "discounted_cash": 13.0, "minimum": 7.818, "maximum": 100.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.38 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.38 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 58.29 }, { "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": 657.0, "discounted_cash": 25.0, "minimum": 9.28, "maximum": 525.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 40.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 138.53 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 138.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.97, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 145.82 }, { "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" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.4893, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 388.29, "10th_percentile": 388.29, "90th_percentile": 388.29, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 34.84, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "*AMITRIP & NORTRIP COMBINED", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.0, "discounted_cash": 114.0, "minimum": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "*COCCIDIODES ANTIBODY", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.0, "discounted_cash": 11.0, "minimum": 6.882, "maximum": 82.4, "payers_information": [ { "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": "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "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 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 Medicare", "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 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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "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": 11.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "17 HYDROXPROGESTERONE", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.0, "discounted_cash": 27.0, "minimum": 9.28, "maximum": 101.0, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.6, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 101.0 }, { "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" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 36.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "17 KETOSTEROID 24 HR URINE", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 12.0, "minimum": 7.68, "maximum": 151.2, "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": "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 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 Medicare", "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 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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "*COXSACKIE A, 10 ANTIBODY", "code_information": [ { "code": "86658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.0, "discounted_cash": 13.0, "minimum": 7.818, "maximum": 100.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.38 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.38 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 58.29 }, { "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": "17 KETOGENIC STEROIDS", "code_information": [ { "code": "83582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 249.0, "discounted_cash": 15.0, "minimum": 9.28, "maximum": 199.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "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": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.02 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 32.89 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "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": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "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": 17.79, "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": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "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": 16.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "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": 15.47, "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": 15.47, "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": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "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": 15.93, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "17 HYDROXYPREGNENOLONE, LC/MS", "code_information": [ { "code": "84143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.0, "discounted_cash": 22.0, "minimum": 9.28, "maximum": 194.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "120.00% 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": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "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": 9.74 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 9.28 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "3D CARDIAC MAPPING", "code_information": [ { "code": "93613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15162.0, "minimum": 232.0, "maximum": 15148.5, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5524.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5524.79 }, { "payer_name": "Community Partners Health plan", "plan_name": "Community Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9659.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5524.79 }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 13000.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5524.79 }, { "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": 5801.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5801.03 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.36 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15148.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5524.79 } ] } ] }, { "description": "*NORCLOZAPINE", "code_information": [ { "code": "83789", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.0, "discounted_cash": 24.0, "minimum": 8.41, "maximum": 91.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "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": 25.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 32.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 33.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.06, "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": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "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": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 37.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "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": 27.73, "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": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.96 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.32, "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": 24.11, "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": 24.11, "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": 21.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "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": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.93, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "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": 24.83, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "3D RENDERING AT IND WKST-MRI", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1502.0, "minimum": 38.55, "maximum": 1502.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1502.0 }, { "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": 1502.0 }, { "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": 38.55, "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": 38.55 } ] } ] }, { "description": "17-OH CORTICOSTEROIDS", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.0, "discounted_cash": 17.0, "minimum": 9.28, "maximum": 118.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 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 Medicare", "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 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "3D RECONSTRUCTION", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1259.0, "minimum": 14.85, "maximum": 1259.0, "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": 1259.0 }, { "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": 14.85, "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": 14.85 } ] } ] }, { "description": "*URINE CREATININE RANDOM", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 99.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9254, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 73.28, "10th_percentile": 73.28, "90th_percentile": 73.28, "count": "15" }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 42.16, "10th_percentile": 42.16, "90th_percentile": 42.16, "count": "1 through 10" }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.85 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.85 }, { "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": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 106.2, "10th_percentile": 106.2, "90th_percentile": 106.2, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.89 }, { "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": "3D RENDERING NO IND WKST-MRI", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1259.0, "minimum": 14.85, "maximum": 1259.0, "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": 14.85, "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": 14.85 } ] } ] }, { "description": "2.0MM ASNINS MICRO CANNULATED", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "4.0 X65MM TI CANNULATED SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "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": 252.71, "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": "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": 252.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 730.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 513.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1963.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 838.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.71 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.71 }, { "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": 265.35 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 252.71 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "3D RENDERING W/POST PROCESS", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1023.0, "minimum": 38.55, "maximum": 1502.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1023.0 }, { "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": 1023.0 }, { "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": 38.55, "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": 38.55 } ] } ] }, { "description": "2.0X22MM SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "14-3-3 PROTEIN, CSF - 83520 - 30190075", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161.0, "discounted_cash": 17.0, "minimum": 8.41, "maximum": 174.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 26.4231, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 65.01, "10th_percentile": 65.01, "90th_percentile": 65.01, "count": "1 through 10" }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 127.52 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 127.52 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 134.23 }, { "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": "3.0X24 SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "A. GALACTOMANNAN AG-BRONCH", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 278.0, "discounted_cash": 11.0, "minimum": 7.188, "maximum": 222.4, "payers_information": [ { "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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" } ] } ] }, { "description": "17-KETOSTEROIDS", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.0, "discounted_cash": 12.0, "minimum": 7.68, "maximum": 151.2, "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": "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": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 9.74 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 9.28 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "5-A-DIHYDROTESTOSTERONE", "code_information": [ { "code": "82642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.0, "discounted_cash": 29.0, "minimum": 9.28, "maximum": 110.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 39.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "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": 47.43, "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": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 32.73 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "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": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 45.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "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": 33.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 32.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.46 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "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": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "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": 29.28, "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": 30.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "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": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "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": 30.16, "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": 190.0, "discounted_cash": 12.0, "minimum": 7.74, "maximum": 152.0, "payers_information": [ { "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": 9.74 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 9.28 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "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": 13.29, "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": 15.48, "additional_payer_notes": "120.00% 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": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN (2 VIEWS)", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.0, "discounted_cash": 111.0, "minimum": 23.39, "maximum": 516.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 133.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 242.03 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 29.04 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 172.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "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 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 Medicare", "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": 23.39, "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": 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": 23.39 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "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": 105.0, "discounted_cash": 15.0, "minimum": 8.1, "maximum": 84.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "5NUCLEOTIDASE", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.0, "discounted_cash": 11.0, "minimum": 6.69, "maximum": 68.8, "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": "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": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "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": 8.83 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ABDOMEN PREGNANCY", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 587.0, "discounted_cash": 92.0, "minimum": 19.43, "maximum": 469.6, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 346.92, "10th_percentile": 346.92, "90th_percentile": 346.92, "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 24.26 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 20.0, "median_amount": 117.4, "10th_percentile": 117.4, "90th_percentile": 117.4, "count": "1 through 10" }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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": 176.1, "10th_percentile": 176.1, "90th_percentile": 176.1, "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": 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 Medicare", "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": 19.43, "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": 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": 19.43 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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. FUMIGATUS #6 AB", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 15.0, "minimum": 8.1, "maximum": 84.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "6-MONOACETYL MORPHINE-FREE", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 292.0, "discounted_cash": 114.0, "minimum": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 292.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "A-THALASSEMIA 7 DELETIONS", "code_information": [ { "code": "81257", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1263.0, "discounted_cash": 102.0, "minimum": 32.76, "maximum": 1263.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 122.71, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "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": 107.37, "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": 32.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 138.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 97.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 143.16, "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": 165.66, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 424.98 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 114.74 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 231.98 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.36, "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": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 158.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "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": 117.6, "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": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 112.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.28 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 107.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 153.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.37, "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": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "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": 102.26, "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": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.71, "additional_payer_notes": "A Indicator - 110.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 127.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 102.26, "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": 105.33, "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": 7337.25, "discounted_cash": 1654.0, "minimum": 179.61, "maximum": 5869.8, "payers_information": [ { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1169.0 }, { "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": 2267.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2233.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2267.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1571.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2564.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2267.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2233.83 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2233.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2267.18 }, { "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": 2380.54 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2380.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.61, "additional_payer_notes": "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": 179.61 }, { "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": 2266.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2267.18 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 2351.4 }, { "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" } ] } ] }, { "description": "ABBREVIATED IDENTIFICATION", "code_information": [ { "code": "87088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.0, "discounted_cash": 8.0, "minimum": 4.854, "maximum": 92.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 12.3777, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 68.76, "10th_percentile": 68.76, "90th_percentile": 68.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "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": 8.49, "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": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "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": 8.09, "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 Health Spring", "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": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 69.88 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "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": 9.3, "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": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 69.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.73 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "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": 8.09, "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": 8.09, "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": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "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": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 73.56 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "A. FUMIGATUS #3 AB", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 15.0, "minimum": 8.1, "maximum": 84.0, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "A. FLAVUS AB", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 15.0, "minimum": 8.1, "maximum": 84.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% 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": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% 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": "ABDOMEN W/CONTRAST", "code_information": [ { "code": "74182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5740.0, "discounted_cash": 372.0, "minimum": 202.53, "maximum": 4592.0, "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": "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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.04 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.04 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.69 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.69 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 202.53, "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": 202.53 }, { "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": 352.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.04 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "A. PULLULANS AB", "code_information": [ { "code": "86331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.0, "discounted_cash": 11.0, "minimum": 4.872, "maximum": 47.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 47.0 }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 #2 AB", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 15.0, "minimum": 8.1, "maximum": 84.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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" } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% 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": "ABDOMEN WO CONTRAST", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2608.0, "discounted_cash": 111.0, "minimum": 74.62, "maximum": 2086.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 133.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": 92.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.54 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1146.67 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1146.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.54 }, { "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": 97.17 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 74.62, "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": 74.62 }, { "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": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 92.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.54 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 1207.02 }, { "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 KUB 1 VIEW", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 587.0, "discounted_cash": 92.0, "minimum": 19.43, "maximum": 469.6, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 346.92, "10th_percentile": 346.92, "90th_percentile": 346.92, "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": 48.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 24.26 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 20.0, "median_amount": 117.4, "10th_percentile": 117.4, "90th_percentile": 117.4, "count": "1 through 10" }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 176.1, "10th_percentile": 176.1, "90th_percentile": 176.1, "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": 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": 51.14 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 19.43, "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": 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": 19.43 }, { "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": 48.7 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "AAA CUTDOWN UNILATERAL", "code_information": [ { "code": "34812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3034.0, "minimum": 203.23, "maximum": 3034.0, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3034.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3034.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3034.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3034.0 }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3034.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3034.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3034.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.23, "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": 203.23 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3034.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3034.0 } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% 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": "ABDOMEN/PELVIS W/O CONTRAST", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8446.0, "discounted_cash": 254.0, "minimum": 94.66, "maximum": 6756.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 305.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "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": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 343.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 279.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 94.66, "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": 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": 94.66 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 263.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ABDOMEN W/WO CONTRAST - 74170 - 35000005", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5675.0, "discounted_cash": 187.0, "minimum": 177.688, "maximum": 4540.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 224.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 252.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 177.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 261.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1941.69 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1941.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 276.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 178.22, "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": 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": 178.22 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 263.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 2043.88 }, { "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": "AAA SCREENING", "code_information": [ { "code": "76706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.0, "discounted_cash": 111.0, "minimum": 42.63, "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": 133.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 245.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 89.73 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 172.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "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": 99.52 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 73.41, "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": 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": 73.41 }, { "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": 94.78 }, { "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": 245.0, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABSCESS CATH EXCHANGE", "code_information": [ { "code": "49423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2699.0, "discounted_cash": 2046.0, "minimum": 63.1, "maximum": 2699.0, "payers_information": [ { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1169.0 }, { "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": 625.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2699.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 625.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1943.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 2699.0, "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": 2699.0, "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": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2699.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2699.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 625.68 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2699.0 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2699.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 625.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 656.96 }, { "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": 2699.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 656.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 63.1, "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": 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": 63.1 }, { "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": 625.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 625.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 2699.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2557.81, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 2699.0 }, { "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" } ] } ] }, { "description": "ABDOMEN/PELVIS W/WO CONTRAST", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10828.0, "discounted_cash": 372.0, "minimum": 224.48, "maximum": 8662.4, "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": "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": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 3248.4, "10th_percentile": 3248.4, "90th_percentile": 3248.4, "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 224.48, "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": 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": 224.48 }, { "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": 263.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 WITH CONTRAST", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3394.0, "discounted_cash": 187.0, "minimum": 157.18, "maximum": 2715.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 224.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 252.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 177.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 261.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1471.88 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1471.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 276.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 157.18, "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": 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": 157.18 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 263.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 1549.35 }, { "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": "ABD/PEL ANGIO W/WO CONT", "code_information": [ { "code": "74174", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4341.0, "discounted_cash": 372.0, "minimum": 254.28, "maximum": 3472.8, "payers_information": [ { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 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 Medicare", "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": 254.28, "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": 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": 254.28 }, { "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": 321.92 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" }, { "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": "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 800.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 341.0 } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% 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/PELVIS WITH CONTRAST", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9845.0, "discounted_cash": 372.0, "minimum": 198.04, "maximum": 7876.0, "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": "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 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 Medicare", "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": 198.04, "additional_payer_notes": "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": 198.04 }, { "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": 263.48 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 LAT DECUB BILATERAL", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.0, "discounted_cash": 111.0, "minimum": 23.39, "maximum": 516.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 133.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 242.03 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 29.04 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 172.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 51.14 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 23.39, "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": 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": 23.39 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACROMIOCLAVICULAR JOINTS", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 983.0, "discounted_cash": 92.0, "minimum": 19.43, "maximum": 786.4, "payers_information": [ { "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": 51.14 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 19.43, "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": 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": 19.43 }, { "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": 48.7 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 223.45 }, { "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": "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": 48.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 212.28 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 212.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8563.0, "minimum": 5830.7582, "maximum": 13873.3722, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10276.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8563.81, "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": 8992.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 10575.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 10376.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10425.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11030.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 10704.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8135.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8563.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8563.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 13414.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 11989.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 13873.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8563.81, "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": 8628.46 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8563.81, "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": 8649.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13273.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10654.37 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8563.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10654.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8563.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9420.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8563.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8992.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8992.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12845.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8820.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8992.0, "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": 8563.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8563.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8289.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8563.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8563.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 8563.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 8563.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11215.13 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8820.72, "additional_payer_notes": "103.00% of Medicare 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% 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": "ABDOMEN W/O CONTRAST", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4058.0, "discounted_cash": 254.0, "minimum": 116.62, "maximum": 3246.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 305.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 343.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1854.71 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1854.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.24 }, { "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": 1217.4, "10th_percentile": 1217.4, "90th_percentile": 1217.4, "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": 219.7 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 219.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 116.62, "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": 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": 116.62 }, { "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": 209.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.24 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 1952.33 }, { "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": "ACTIVATED COAGULAT TIME", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.0, "discounted_cash": 4.0, "minimum": 2.568, "maximum": 116.44, "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": "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": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 110.62 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 110.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 3.27 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 3.11 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 116.44 }, { "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": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7310.0, "minimum": 4454.8, "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": 8772.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7675.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8873.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8706.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8747.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9254.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 9137.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6944.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11255.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 10234.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11842.25, "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": 7310.03, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7383.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11330.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9185.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9185.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8041.03, "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": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7675.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7675.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10965.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7529.33, "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": 7675.53, "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": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4454.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 7310.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9669.21 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7529.33, "additional_payer_notes": "103.00% of Medicare 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% 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": "ABDOMEN W/WO CONTRAST - 74183 - 61000005", "code_information": [ { "code": "74183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7271.0, "discounted_cash": 372.0, "minimum": 214.73, "maximum": 5816.8, "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": "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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.04 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4008.84 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4008.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.04 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.69 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.69 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 214.73, "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": 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": 214.73 }, { "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": 352.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.04 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 4219.83 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% 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 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% 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": "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": "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" }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% 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" } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% 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": "ABSCESS CULTURE", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 8.0, "minimum": 5.172, "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": 10.34, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 100.05 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 100.05 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 105.32 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% 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": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8233.0, "minimum": 3273.2, "maximum": 13338.5454, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9880.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8645.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 10127.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9936.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9983.22 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10562.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 10292.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7821.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12845.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 11527.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 13338.55, "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": 8233.67, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8316.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12762.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7961.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7961.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9057.04, "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": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8645.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8645.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12350.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8480.68, "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": 8645.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6379.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 8233.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8380.12 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8480.68, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABSCESS DRAINAGE W/CATH PLAC", "code_information": [ { "code": "75989", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1515.0, "minimum": 53.28, "maximum": 1460.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.3 }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.3 }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 824.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 184.07 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 184.07 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.28, "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": 53.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.3 } ] } ] }, { "description": "ABSCESSOGRAM", "code_information": [ { "code": "49424", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 366.0, "minimum": 32.95, "maximum": 366.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 366.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.04 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 366.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.04 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.24 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "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": 32.95 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 283.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.04 } ] } ] }, { "description": "ABLATION, EXT VEIN 1ST", "code_information": [ { "code": "36475", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5129.0, "discounted_cash": 3367.0, "minimum": 265.04, "maximum": 5172.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1771.0 }, { "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": 2358.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2358.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 5129.0, "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": "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": 1467.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5129.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2358.67 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5129.0 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5129.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2358.67 }, { "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": "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": 2476.6 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2476.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 265.04, "additional_payer_notes": "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": 265.04 }, { "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": 2357.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2358.67 }, { "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": 5129.0, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "case rate", "standard_charge_dollar": 5129.0 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% 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": "ABUS LEFT COMPLETE", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1455.0, "discounted_cash": 111.0, "minimum": 60.9, "maximum": 1746.4, "payers_information": [ { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 631.26 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 75.75 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 122.34 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 172.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "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": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 654.9, "10th_percentile": 654.9, "90th_percentile": 654.9, "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": 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 60.9, "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": 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": 60.9 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health 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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1290.15, "10th_percentile": 1290.15, "90th_percentile": 1290.15, "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" } ] } ] }, { "description": "ABSOLUTE CD57+CD3", "code_information": [ { "code": "86356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.0, "discounted_cash": 26.0, "minimum": 16.0, "maximum": 168.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "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": 28.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 36.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 37.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.38, "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": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.69 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 30.16 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 62.11 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 41.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.71 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "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": 30.8, "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": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 29.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.83 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.15 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.58, "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": 28.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "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": 26.78, "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": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "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": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "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": 27.58, "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% 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": "ABUS RIGHT COMPLETE", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1455.0, "discounted_cash": 111.0, "minimum": 60.9, "maximum": 1746.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 133.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1290.15, "10th_percentile": 1290.15, "90th_percentile": 1290.15, "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": 94.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 631.26 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 75.75 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 122.34 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 172.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "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": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 654.9, "10th_percentile": 654.9, "90th_percentile": 654.9, "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": 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": 99.52 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 60.9, "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": 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": 60.9 }, { "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": 94.78 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare 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": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "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": 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% 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" } ] } ] }, { "description": "ACETONE, QUALITATIVE", "code_information": [ { "code": "82009", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.0, "discounted_cash": 4.0, "minimum": 2.712, "maximum": 89.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.07 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 5.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.35 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.71, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.2 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.55 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.32 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACETAMINOPHEN (TYLENOL)", "code_information": [ { "code": "80143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 358.0, "discounted_cash": 18.0, "minimum": 8.53, "maximum": 286.4, "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": "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": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "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": 8.96 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 8.53 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% 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": "ACETYLCHOLINE BINDING AB", "code_information": [ { "code": "86041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.0, "discounted_cash": 18.0, "minimum": 8.1, "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": "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": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 67.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 8.51 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 8.1 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 43.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ACETONE, QUANTITATIVE", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 8.0, "minimum": 3.8, "maximum": 75.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.3 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.3 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 57.16 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% 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 PHOSPHOTASE, PROSTATIC", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 9.0, "minimum": 3.8, "maximum": 100.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.59, "additional_payer_notes": "120.00% 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": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "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": 3.99 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 3.8 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "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": 9.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACETYLCHOLINE RECEPTOR BINDING", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 18.0, "minimum": 8.41, "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": 22.08, "additional_payer_notes": "120.00% 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": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 8.83 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 135.0 }, { "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 MODULE", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.0, "discounted_cash": 11.0, "minimum": 6.918, "maximum": 201.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 17.6409, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 148.93, "10th_percentile": 148.93, "90th_percentile": 446.8, "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.42 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.42 }, { "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" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 85.71 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% 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": "ACETYLCHOLINE RECEPTOR BLOCK", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 18.0, "minimum": 8.41, "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": 22.08, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 135.0 }, { "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 WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10247.0, "minimum": 7787.727, "maximum": 61317.2809, "payers_information": [ { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30330.94 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10555.44, "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": 12297.55, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10248.0, "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": 10760.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12861.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12619.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12679.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13415.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 12809.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9735.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10248.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10248.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16315.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 14347.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 16601.7, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10248.0, "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": 10494.08 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10248.0, "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": 10350.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15884.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28814.39 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10248.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28814.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10248.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11272.8, "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": 10248.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10760.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10760.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15371.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10555.44, "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": 10760.4, "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": 10247.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10247.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13698.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10248.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10247.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 10248.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 10248.0, "additional_payer_notes": "100.00% 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% 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": "ACHR GANGANGLIONIC (ALPHA3) AB", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 18.0, "minimum": 8.41, "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": 22.08, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 135.0 }, { "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, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6391.0, "minimum": 4617.7166, "maximum": 32914.46, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7670.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6391.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6711.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7626.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7483.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7518.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7954.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 7989.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6072.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6391.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6391.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9673.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 8948.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10354.76, "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": 6391.83, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6391.83, "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": 6455.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9907.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31268.74 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6391.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31268.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6391.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7031.01, "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": 6391.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6711.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6711.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9587.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6583.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 6711.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6391.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6391.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8946.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6391.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6391.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 6391.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 6391.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32914.46 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6583.58, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7996.0, "minimum": 5937.0642, "maximum": 34512.33, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9596.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8396.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9805.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9621.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9666.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10227.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 9995.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7596.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7996.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7996.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12437.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 11195.44, "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": 12954.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.74, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.74, "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": 8076.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12394.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32786.71 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32786.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8796.41, "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": 7996.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8396.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8396.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11995.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8236.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8396.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7996.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10553.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7996.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 7996.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34512.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8236.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACP ABD/PEL/L EXT 2ND", "code_information": [ { "code": "36216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4232.0, "minimum": 261.78, "maximum": 4232.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4232.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 622.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 622.63 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 261.78, "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": 261.78 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 592.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 } ] } ] }, { "description": "ACTH STIMULATION PANEL", "code_information": [ { "code": "80400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.0, "discounted_cash": 32.0, "minimum": 19.572, "maximum": 142.4, "payers_information": [ { "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": 25.83 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 24.6 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" }, { "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": "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": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 44.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 30.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 } ] } ] }, { "description": "ACUTE HEPATITIS PANEL (A,B,C)", "code_information": [ { "code": "80074", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 647.0, "discounted_cash": 47.0, "minimum": 6.35, "maximum": 517.6, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 72.8739, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 382.38, "10th_percentile": 382.38, "90th_percentile": 382.38, "count": "1 through 10" }, { "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": 6.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 73.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 384.22 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 384.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 6.67 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 6.35 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 404.44 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% 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": "ACYLCARNITINE, PLASMA QNT", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 16.0, "minimum": 8.41, "maximum": 112.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "120.00% 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": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "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": 8.83 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 8.41 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% 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": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21796.0, "minimum": 15201.6514, "maximum": 65682.27, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 26156.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21796.9, "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": 22886.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 28541.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 28005.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 28136.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 29769.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 27246.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20707.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 21796.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21796.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 36204.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 30515.67, "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": 35310.99, "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": 21796.9, "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": 23287.47 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 21796.9, "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": 22014.87, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 33785.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62398.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21796.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62398.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21796.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 23976.59, "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": 21796.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22886.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 22886.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 32695.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22450.81, "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": 22886.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21796.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21796.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29038.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21796.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 21796.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 21796.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 21796.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 65682.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22450.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14034.0, "minimum": 7479.04, "maximum": 28703.3, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 16841.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14034.2, "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": 14735.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 18002.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 17663.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17746.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18776.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 17542.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13332.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 22835.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 19647.84, "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": 22735.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 14034.2, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 14034.2, "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": 14174.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 21752.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27268.14 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27268.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15437.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14735.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14735.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21051.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14455.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 14735.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14034.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14034.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7479.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14034.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 14034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 14034.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28703.3 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14455.23, "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": 6878.0, "minimum": 3006.77, "maximum": 11143.818, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8254.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6878.9, "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": 7222.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8287.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8131.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8169.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8644.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 8598.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6534.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6878.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6878.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10512.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 9630.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11143.82, "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": 6878.9, "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": 6761.99 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6878.9, "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": 6947.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10662.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9845.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6878.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9845.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6878.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7566.79, "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": 6878.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7222.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7222.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10318.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7085.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7222.85, "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": 6878.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6878.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3006.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6878.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6878.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 6878.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 6878.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10364.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7085.27, "additional_payer_notes": "103.00% of Medicare 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% 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": "AFB CULTURE; ISOLATION & ID", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.0, "discounted_cash": 10.0, "minimum": 6.48, "maximum": 169.6, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.85 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.85 }, { "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 Medicare", "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" }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 161.95 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% 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": "AFP, TOTAL AND L3 PERCENT", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 292.0, "discounted_cash": 64.0, "minimum": 19.8, "maximum": 287.7581, "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": "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": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 86.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 61.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 20.79 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 19.8 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% 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": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10016.0, "minimum": 5590.2962, "maximum": 23957.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12019.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10016.5, "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": 10517.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12547.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12311.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12369.34 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13087.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 12520.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9515.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10016.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10016.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15916.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 14023.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 16226.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10016.5, "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": 10237.64 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10016.5, "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": 10116.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15525.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16356.73 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10016.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16356.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10016.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11018.15, "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": 10016.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10517.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10517.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15024.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10317.0, "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": 10517.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10016.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10016.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23957.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10016.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10016.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 10016.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 10016.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17217.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10317.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7914.0, "minimum": 5869.3726, "maximum": 37802.87, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8705.83, "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": 7914.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8310.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8310.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11871.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8151.82, "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": 8310.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7914.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9973.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7914.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 7914.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37802.87 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8151.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9497.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8310.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9693.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9511.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9555.91 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10110.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 9892.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7518.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7914.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7914.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12296.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 11080.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12821.31, "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": 7914.39, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.39, "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": 7993.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12267.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35912.73 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35912.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.39, "additional_payer_notes": "100.00% 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% 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": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16977.0, "minimum": 10860.867, "maximum": 111790.49, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 20373.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16977.5, "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": 17826.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 21998.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 21584.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21686.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22944.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 21221.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16128.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16977.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16977.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 27904.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 23768.54, "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": 27503.6, "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": 16977.5, "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": 17948.79 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 16977.5, "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": 17147.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 26315.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 106200.97 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16977.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 106200.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16977.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18675.25, "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": 16977.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17826.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17826.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25466.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17486.83, "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": 17826.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16977.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16977.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19598.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16977.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16977.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 16977.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 16977.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 111790.49 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17486.83, "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": 15261.0, "minimum": 10029.0466, "maximum": 41187.56, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18313.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15261.5, "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": 16024.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 19668.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 19298.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19389.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20514.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 19076.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14498.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 24949.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 21366.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 24723.69, "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": 15261.5, "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": 16047.89 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15261.5, "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": 15414.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23655.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39128.18 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39128.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16787.65, "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": 15261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16024.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16024.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22892.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15719.35, "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": 16024.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15261.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15261.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20011.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15261.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 15261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 15261.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41187.56 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15719.35, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACYLCARNITINE, QUANT", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 16.0, "minimum": 8.41, "maximum": 112.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% 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": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43421.0, "minimum": 18576.1348, "maximum": 150690.79, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 52105.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43421.2, "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": 45592.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 57901.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 56812.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 57078.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 60391.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 54276.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41250.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 43421.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 43421.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 73446.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 60789.67, "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": 70342.33, "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": 43421.2, "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": 47241.85 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 43421.2, "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": 43855.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 67302.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 143156.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43421.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 143156.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 43421.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 47763.32, "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": 43421.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45592.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 45592.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 65131.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 44723.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 45592.26, "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": 43421.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43421.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 88441.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43421.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 43421.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 43421.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 43421.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 150690.79 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 44723.84, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28881.0, "minimum": 23105.8252, "maximum": 103935.56, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 34657.79, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28881.5, "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": 30325.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 38160.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 37442.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 37618.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 39801.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 36101.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27437.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 28881.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 28881.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 48405.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 40434.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 46788.01, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 28881.5, "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": 31135.44 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 28881.5, "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": 29170.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 44766.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 98738.78 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28881.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 98738.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28881.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 31769.65, "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": 28881.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30325.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 30325.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 43322.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 29747.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 30325.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28881.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28881.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38454.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28881.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 28881.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 28881.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 28881.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 103935.56 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 29747.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADALIMUMAB ACT&NEUT AB", "code_information": [ { "code": "86352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.0, "discounted_cash": 135.0, "minimum": 28.71, "maximum": 943.0, "payers_information": [ { "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": "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 183.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 129.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 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 Medicare", "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 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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13235.0, "minimum": 8185.5046, "maximum": 45834.98, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15882.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13235.6, "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": 13897.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 16918.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 16600.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16677.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17645.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 16544.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12573.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 21460.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 18529.84, "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": 21441.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13235.6, "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": 13803.65 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13235.6, "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": 13367.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 20515.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43543.23 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43543.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14559.16, "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": 13235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13897.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13897.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19853.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13897.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 13235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 13235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45834.98 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9811.0, "minimum": 4688.85, "maximum": 16886.7253, "payers_information": [ { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15207.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13722.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9811.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13722.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9811.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10792.52, "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": 9811.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10301.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10301.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14717.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10105.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10301.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9811.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9811.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4688.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9811.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9811.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 9811.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 9811.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14444.38 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10105.72, "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": 11773.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9811.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10301.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12269.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12038.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12094.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12796.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 12264.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9320.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9811.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9811.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15563.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 13735.93, "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": 15894.44, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9811.38, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9811.38, "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": 9909.49, "additional_payer_notes": "101.00% of Medicare 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": 8.53, "maximum": 140.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "120.00% 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": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 52.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 59.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 8.96 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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" }, { "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": 8.53 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6151.0, "minimum": 4420.3892, "maximum": 28784.46, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7382.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6459.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7300.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7163.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7196.82 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7614.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 7689.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5844.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9260.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 8612.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 9965.9, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6151.79, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6213.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9535.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27345.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27345.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6766.97, "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": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6459.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6459.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9227.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6336.34, "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": 6459.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7987.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 6151.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28784.46 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6336.34, "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": 16161.0, "minimum": 6164.7332, "maximum": 50149.92, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 19394.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16161.9, "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": 16970.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 20891.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 20498.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20594.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21789.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 20202.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15353.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 26500.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 22626.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 26182.23, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 16161.9, "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": 17045.24 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 16161.9, "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": 16323.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 25050.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47642.42 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47642.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17778.09, "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": 16161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16970.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16970.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24242.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16646.76, "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": 16970.0, "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": 16161.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16161.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27462.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16161.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 16161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 16161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50149.92 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16646.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN SERUM", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 4.0, "minimum": 2.97, "maximum": 155.04, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.5735, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 108.15, "10th_percentile": 108.15, "90th_percentile": 108.15, "count": "1 through 10" }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.29 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.29 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 155.04 }, { "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": "ADAMTS-13 ACTIVITY", "code_information": [ { "code": "85397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.0, "discounted_cash": 30.0, "minimum": 17.81, "maximum": 200.0, "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": "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": 17.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.04 }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 47.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 18.7 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 17.81 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5427.0, "minimum": 3824.5754, "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": 6512.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5698.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6316.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6197.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6226.78 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6588.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 6783.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5155.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8012.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 7597.83, "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": 8791.77, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5427.02, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5481.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 8411.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11452.92 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11452.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5969.72, "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": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5698.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5698.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8140.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5589.83, "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": 5698.37, "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": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6052.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 5427.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12055.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5589.83, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCHOL, UR CONFIRMATION", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.0, "discounted_cash": 114.0, "minimum": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 368.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ADENOVIRUS QT BY PCR", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "discounted_cash": 42.0, "minimum": 25.704, "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": 51.41, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 57.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 66.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "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 Medicare", "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" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACYCLOVIR SERUM", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 673.0, "discounted_cash": 114.0, "minimum": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 475.38 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% 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": "ADENOSINE DEAMINASE,PERICARD F", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 8.0, "minimum": 3.8, "maximum": 81.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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": 16.43 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "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": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADENOSINE DEAMINASE,PLEURAL FL", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 8.0, "minimum": 3.8, "maximum": 81.6, "payers_information": [ { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "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": 8.34, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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": 16.43 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "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" } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% 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": "ADL TRAINING/EA 15 - 97535 - 42000010", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.0, "discounted_cash": 31.0, "minimum": 26.28, "maximum": 153.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "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": 32.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 41.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 43.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.38, "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": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1 }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 48.21, "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": 153.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "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": 35.77, "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": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 34.21, "additional_payer_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": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.59 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.59 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "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": 31.1, "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": 31.1 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "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": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.21, "additional_payer_notes": "A Indicator - 110.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 79.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.03, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS QL BY PCR", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.0, "discounted_cash": 35.0, "minimum": 21.054, "maximum": 181.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.65 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% 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": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11644.0, "minimum": 8935.9298, "maximum": 44509.6862, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11644.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16011.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11644.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11644.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 11644.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 11644.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36789.82 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11994.04, "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": 13973.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11644.7, "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": 12226.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14758.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14480.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14548.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15392.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 14555.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11062.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11644.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11644.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 18720.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 16302.54, "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": 18864.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11644.7, "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": 12041.3 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11644.7, "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": 11761.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18049.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34950.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11644.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34950.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11644.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12809.17, "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": 11644.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12226.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12226.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17467.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11994.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 12226.94, "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": 11644.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS ANTIBODY", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 12.0, "minimum": 7.722, "maximum": 84.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "120.00% 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": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "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": 8.51 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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 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": 8.1 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% 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": "ALCOHOL, BREATH TESTING", "code_information": [ { "code": "82075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.0, "discounted_cash": 30.0, "minimum": 1.0, "maximum": 36.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 36.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 36.0, "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": 36.0, "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": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 33.84 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "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": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 36.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "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": 34.5, "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": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "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": 36.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "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": 30.0, "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": 30.0, "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": 12.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "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": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% 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": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17800.0, "minimum": 12462.1658, "maximum": 55652.12, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21361.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17801.0, "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": 18691.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 23116.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 22681.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 22788.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24110.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 22251.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16910.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17801.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17801.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 29322.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 24921.34, "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": 28837.56, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 17801.0, "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": 18860.94 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 17801.0, "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": 17979.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 27591.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52869.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17801.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52869.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17801.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 19581.1, "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": 17801.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18691.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18691.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26701.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18335.03, "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": 18691.05, "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": 17800.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26403.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17801.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17800.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 17801.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 17801.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55652.12 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18335.03, "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": 1066.0, "discounted_cash": 40.0, "minimum": 24.45, "maximum": 852.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 55.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 249.57 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 249.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 25.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 24.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.9, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 262.7 }, { "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 - 82040 - 30000520", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 4.0, "minimum": 2.97, "maximum": 155.04, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.5735, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 108.15, "10th_percentile": 108.15, "90th_percentile": 108.15, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.29 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 155.04 }, { "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": "ADL TRAINING/EA 15 - 97535 - 43000010", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.0, "discounted_cash": 31.0, "minimum": 26.28, "maximum": 153.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "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": 32.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 41.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 43.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.38, "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": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1 }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 48.21, "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": 153.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "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": 35.77, "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": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 34.21, "additional_payer_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": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "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": 31.1, "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": 31.1 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "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": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.21, "additional_payer_notes": "A Indicator - 110.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 79.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.03, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL CORTEX AB", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 18.0, "minimum": 8.41, "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": 22.08, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 135.0 }, { "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": "ALK PHOS, BONE SPECIFIC", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 96.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% 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": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.51 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 91.06 }, { "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": "ADMN SARSCOV2 VACC 1 DOSE", "code_information": [ { "code": "90480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.0, "discounted_cash": 43.0, "minimum": 18.618, "maximum": 95.8247, "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": "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": 33.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 58.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 41.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 67.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 35.37 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 33.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 38.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ADRENAL SCAN", "code_information": [ { "code": "78075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2921.0, "discounted_cash": 1380.0, "minimum": 324.16, "maximum": 2921.0, "payers_information": [ { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2921.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 411.84 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 640.82 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "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": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2139.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 763.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1587.64, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 763.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1518.62, "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": 1442.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1449.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 801.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1449.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2070.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 801.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1421.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1449.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 324.16, "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": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 324.16 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "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": 762.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 763.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2921.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1725.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "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": 1421.98, "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": 1656.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1449.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 763.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1863.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 763.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1311.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1380.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 1932.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2236.51, "additional_payer_notes": "162.00% of Medicare Rates" } ] } ] }, { "description": "ALKALINE PHOSPHATASE QUEST", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 96.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.51 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.51 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 91.06 }, { "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": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11771.0, "minimum": 7147.87, "maximum": 27600.54, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14125.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11771.3, "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": 12359.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14930.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14649.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14718.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15572.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 14714.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11182.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11771.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11771.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 18938.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 16479.82, "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": 19069.51, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11771.3, "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": 12181.56 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11771.3, "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": 11889.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18245.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26220.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11771.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26220.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11771.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12948.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11771.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12359.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12359.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17656.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12124.44, "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": 12359.87, "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": 11771.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11771.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7147.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11771.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11771.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 11771.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 11771.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27600.54 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12124.44, "additional_payer_notes": "103.00% 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% 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 ANIMAL PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7632.0, "minimum": 4009.5, "maximum": 12364.5042, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9158.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8014.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9310.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9135.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9178.49 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9711.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 9540.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7250.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7632.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7632.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11810.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 10685.37, "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": 12364.5, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.41, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.41, "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": 7708.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11830.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8250.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8250.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8395.65, "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": 7632.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8014.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8014.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11448.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7861.38, "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": 8014.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7632.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7632.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 7632.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 7632.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8685.02 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7861.38, "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% 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": "AFB SMEAR", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 6.0, "minimum": 4.008, "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": 8.02, "additional_payer_notes": "120.00% 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 102.0 }, { "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" }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 102.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 102.0 }, { "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" } ] } ] }, { "description": "ALLERGEN GROUP 28", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 638.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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, ISOPROPYL", "code_information": [ { "code": "84600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.0, "discounted_cash": 17.0, "minimum": 8.41, "maximum": 70.83, "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": "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 62.26 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 62.26 }, { "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 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 Medicare", "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 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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 65.54 }, { "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": "ADRENOCORTICOTROPHIC HORMONE", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.0, "discounted_cash": 38.0, "minimum": 23.172, "maximum": 312.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 211.78 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 211.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 42.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.34, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 222.93 }, { "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, PERITONEAL FLUID", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.0, "discounted_cash": 20.0, "minimum": 8.1, "maximum": 143.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.8393, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 84.51, "10th_percentile": 84.51, "90th_percentile": 84.51, "count": "1 through 10" }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 28.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.0 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 143.0 }, { "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 INSECT VENOM PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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 : 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% 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": "ADULT IOP DAILY", "code_information": [ { "code": "G0410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 749.0, "minimum": 32.886, "maximum": 749.0, "payers_information": [ { "payer_name": "APS Healthcare", "plan_name": "APS Healthcare Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 140.0 }, { "payer_name": "CARELON (fka Beacon & 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": "HealthLink, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "fee schedule", "standard_charge_dollar": 749.0 }, { "payer_name": "Magellan Behavioral Health", "plan_name": "Magellan Pinnacle Network", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Magellan Behavioral Health", "plan_name": "Magellan Summit Network", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 204.16 }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 99.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Value Options", "plan_name": "Value Options Commercial Non-HMO Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 255.0 } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36216.0, "minimum": 19437.345, "maximum": 61037.86, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 43459.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36216.2, "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": 38027.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 48118.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 47213.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 47435.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 50188.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 45270.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34405.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36216.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36216.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 61037.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 50702.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 58670.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 36216.2, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 36216.2, "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": 36578.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 56135.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29497.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36216.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29497.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36216.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39837.82, "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": 36216.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38027.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 38027.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 54324.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 37302.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 38027.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36216.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36216.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52679.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36216.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 36216.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 36216.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 36216.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31050.02 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37302.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN MOLD PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "ALDOLASE", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 9.0, "minimum": 3.8, "maximum": 120.0, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 120.0 }, { "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" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 119.76 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 119.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 } ] } ] }, { "description": "AFB CULTURE, BLOOD", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.0, "discounted_cash": 10.0, "minimum": 6.48, "maximum": 169.6, "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": "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": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.85 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "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": 7.78 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 7.41 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 161.95 }, { "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": "AIRWAY, SUCTIONING", "code_information": [ { "code": "31720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.0, "discounted_cash": 233.0, "minimum": 37.758, "maximum": 217.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 217.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "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": 217.0, "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": 49.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "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": 217.0, "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": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 217.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 217.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "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": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "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": 217.0, "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": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "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": 217.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.44 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "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": 217.0, "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": 46.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "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": 46.42 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "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": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 217.0, "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": 217.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN SEAFOOD PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 318.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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" } ] } ] }, { "description": "ALLERGEN CEREAL PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5650.0, "minimum": 4008.4922, "maximum": 19126.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 6780.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5933.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6620.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6495.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6526.21 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6905.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 7063.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5368.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8397.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 7911.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 9154.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5650.75, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5707.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 8758.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6779.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6779.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6215.83, "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": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5933.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5933.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8476.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5820.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 5933.29, "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": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19126.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 5650.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7136.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5820.27, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN - 84165 - 30010800", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.0, "discounted_cash": 10.0, "minimum": 3.8, "maximum": 186.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.0 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 70.0 }, { "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" } ] } ] }, { "description": "ALLERGEN SPECIFIC IgE ,QNT", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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 FOOD ALLERGY PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 421.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9522.0, "minimum": 7159.5334, "maximum": 15426.3042, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11426.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9522.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9998.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11876.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11653.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11708.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12387.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 11903.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9046.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9522.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9522.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15065.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 13331.37, "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": 15426.3, "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": 9522.41, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9522.41, "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": 9617.63, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14759.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14520.22 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9522.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14520.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9522.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10474.65, "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": 9522.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9998.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9998.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14283.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9808.08, "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": 9998.53, "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": 9522.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9522.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9522.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9522.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 9522.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 9522.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15284.44 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9808.08, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN GLYCATED", "code_information": [ { "code": "82985", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.0, "discounted_cash": 16.0, "minimum": 7.134, "maximum": 41.0, "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": "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 25.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "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 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 Medicare", "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 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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "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": 17.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN TREE PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 386.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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 GROUP - 86003 - 30010700", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 621.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7019.0, "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": 8423.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7019.5, "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": 7370.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8478.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8319.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8358.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8843.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 8774.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6668.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10754.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 9827.3, "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": 11371.59, "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": 7019.5, "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": 6917.74 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7019.5, "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": 7089.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10880.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9265.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9265.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7721.45, "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": 7019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7370.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7370.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10529.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7230.09, "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": 7370.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9703.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 7019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 7019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9753.43 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7230.09, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, CATFISH", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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" } ] } ] }, { "description": "ALLERGEN GROUP 20", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 504.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "AGNA/SOX1 AB IFA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 168.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.4365, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 124.11, "10th_percentile": 124.11, "90th_percentile": 124.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 113.74 }, { "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": "ALBUMIN, BODY FLUID", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 7.0, "minimum": 3.8, "maximum": 40.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 40.0 }, { "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, IGG LETTUCE", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN GROUP 30", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 673.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "ALBUMIN, CSF", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 7.0, "minimum": 3.8, "maximum": 40.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "120.00% 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": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 40.0 }, { "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, IGG MUSHROOM", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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 PISTACHIO", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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 PEANUT", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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 SPECIFIC IGE; EACH", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% 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 SOYBEAN", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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 CHEDDAR CHEESE", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% 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 WHEAT", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 } ] } ] }, { "description": "ALLERGEN, IGG OLIVES", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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": "ALCOHOL, ETHANOL WITH %", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.0, "discounted_cash": 114.0, "minimum": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 368.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% 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 PORK", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": 8.51 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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 : 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% 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": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14330.0, "minimum": 5832.0, "maximum": 25998.58, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19196.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 17913.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13614.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14330.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14330.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 23346.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 20063.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 23216.07, "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": 14330.9, "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": 15016.99 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 14330.9, "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": 14474.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 22212.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24698.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14330.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24698.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14330.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15763.99, "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": 14330.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15047.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15047.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21496.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14760.83, "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": 15047.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14330.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14330.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11385.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14330.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14330.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 14330.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 14330.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25998.58 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14760.83, "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": 17197.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14330.9, "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": 15047.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 18405.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 18059.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 18143.85 } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% 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 SHRIMP", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1066.0, "discounted_cash": 40.0, "minimum": 24.45, "maximum": 852.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 55.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 249.57 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 249.57 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 262.7 }, { "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": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5566.0, "minimum": 2430.0, "maximum": 9018.297, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 6680.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5566.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5845.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6506.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6383.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6413.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6786.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 6958.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5288.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5566.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5566.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8253.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 7793.59, "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": 9018.3, "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": 5566.85, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5566.85, "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": 5622.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 8628.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7873.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5566.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7873.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5566.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6123.54, "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": 5566.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5845.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5845.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8350.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5733.86, "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": 5845.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5566.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5566.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3746.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5566.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 5566.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 5566.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 5566.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8288.08 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5733.86, "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": 233.0, "discounted_cash": 16.0, "minimum": 8.41, "maximum": 186.4, "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": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 145.03 }, { "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, IGG TURKEY", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 96.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.51 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.51 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 91.06 }, { "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": "ALCOHOL, ETOH", "code_information": [ { "code": "82077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 358.0, "discounted_cash": 17.0, "minimum": 9.84, "maximum": 286.4, "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": "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": 9.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "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": 10.33 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 9.84 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ALPHA-FETOPROTEIN, BODY FLUID", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.0, "discounted_cash": 20.0, "minimum": 8.1, "maximum": 143.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 31.8393, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 84.51, "10th_percentile": 84.51, "90th_percentile": 84.51, "count": "1 through 10" }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 28.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.0 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 143.0 }, { "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,BOTRYTIS CINEREA", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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 DUST PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 318.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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": "ALCOHOL, METHYL", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.0, "discounted_cash": 114.0, "minimum": 11.484, "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": 85.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "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": 85.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "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": 85.0, "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": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 85.0 }, { "payer_name": "Cigna Health Spring", "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": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "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": 85.0, "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": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "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": 85.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "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": 85.0, "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": 85.0, "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": 85.0, "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": 85.0, "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": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "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": 85.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALT (SGPT)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.0, "discounted_cash": 5.0, "minimum": 3.18, "maximum": 241.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 8.109, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 178.48, "10th_percentile": 178.48, "90th_percentile": 178.48, "count": "1 through 10" }, { "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": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.51 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "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": 3.99 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 3.8 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 91.06 }, { "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 : 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% 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 GLUTEN", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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 : 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% 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 GRASS PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 386.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "ALK REARRANGMENT BY FISH", "code_information": [ { "code": "88377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1395.0, "discounted_cash": 181.0, "minimum": 114.09, "maximum": 1395.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 1367.46 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 369.21 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 588.69 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 281.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "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 Medicare", "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": 295.84, "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": 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": 295.84 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALUMINUM, UR", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.0, "discounted_cash": 25.0, "minimum": 8.66, "maximum": 182.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 39.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.29 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 9.09 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 155.04 }, { "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": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13837.0, "minimum": 5934.0678, "maximum": 22497.21, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 16605.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13837.6, "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": 14529.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 17735.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 17402.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17483.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18498.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 17297.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13145.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13837.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13837.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 22497.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 19372.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 22416.96, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13837.6, "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": 14470.55 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13837.6, "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": 13975.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 21448.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16765.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13837.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16765.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13837.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15221.36, "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": 13837.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14529.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14529.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20756.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14252.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 14529.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13837.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13837.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14954.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13837.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13837.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 13837.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 13837.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17648.31 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14252.73, "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": 435.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "ALKALINE PHOSPHATASE ISO QD", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 78.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "120.00% 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": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 78.0 }, { "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" } ] } ] }, { "description": "AMIKACIN, PEAK", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.0, "discounted_cash": 15.0, "minimum": 8.53, "maximum": 62.66, "payers_information": [ { "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% 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 TOTAL IgE", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 196.0, "discounted_cash": 16.0, "minimum": 8.41, "maximum": 156.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 25.1838, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 115.84, "10th_percentile": 115.84, "90th_percentile": 115.84, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 25.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.71 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.85 }, { "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" } ] } ] }, { "description": "ALLERGEN FOOD PANEL #1", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "AMINOLEVULINIC ACID URINE", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.0, "discounted_cash": 16.0, "minimum": 8.41, "maximum": 116.8, "payers_information": [ { "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": 8.41 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" }, { "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": "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": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "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": 8.83 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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" } ] } ] }, { "description": "ALPHA 1 ANTITRYPSIN PHENO", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 544.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 435.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 22.1238, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 321.5, "10th_percentile": 321.5, "90th_percentile": 321.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.43, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "ALLERGEN WEED PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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 STRAWBERRY", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "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": "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": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "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": 8.51 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 8.1 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 } ] } ] }, { "description": "ALPHA GLOBIN HBA 1/2 DEL/DUP", "code_information": [ { "code": "81269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 652.0, "discounted_cash": 202.0, "minimum": 113.448, "maximum": 652.0, "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": "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": 115.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 273.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 192.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 652.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 227.28 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 121.62 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 115.83 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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, FOOD BEEF IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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 NUT PROFILE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 318.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "AMNIOCENTESIS", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1678.0, "discounted_cash": 982.0, "minimum": 79.07, "maximum": 1678.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1178.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1169.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "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": 1031.28, "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": 500.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1325.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 500.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 933.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 1375.04, "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": 1591.12, "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": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "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": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1522.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 500.32 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 420.72 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "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": 1129.5, "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": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 420.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 500.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1080.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.34 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1473.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "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": 1031.28, "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": 79.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "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": 79.07 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "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": 982.17, "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": 500.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 500.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1678.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1227.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 442.86 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA SUBUNIT", "code_information": [ { "code": "82397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 237.6, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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, FOOD PORK IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": 168.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "AMPAR2 AB CBA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 168.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.4365, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 124.11, "10th_percentile": 124.11, "90th_percentile": 124.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 113.74 }, { "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": "ALPHA-1-ANTITRYPSIN, STOOL", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.0, "discounted_cash": 13.0, "minimum": 8.064, "maximum": 168.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 20.5632, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 124.11, "10th_percentile": 124.11, "90th_percentile": 124.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.41 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 103.59 }, { "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": "ALLERGEN, IGG BAKER'S YEAST", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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 CORN", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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" } ] } ] }, { "description": "Amphetamine-Serum", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.0, "discounted_cash": 114.0, "minimum": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 303.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ALPRAZOLAM", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 114.0, "minimum": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 320.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 BEEF", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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 CRAB", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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 BROCCOLI", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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 : 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% 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": "ALLERGEN, IGG CHICKEN", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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" } ] } ] }, { "description": "ALLERGEN, IGG EGG YOLK", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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": "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": 11528.0, "minimum": 8840.7784, "maximum": 40749.7064, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13834.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11528.9, "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": 12105.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14601.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14326.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14393.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15229.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 14411.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10952.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11528.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11528.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 18521.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 16140.5, "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": 18676.87, "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": 11528.9, "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": 11913.08 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11528.9, "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": 11644.19, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17869.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26186.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11528.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26186.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11528.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12681.79, "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": 11528.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12105.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12105.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17293.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11874.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 12105.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11528.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11528.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16276.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11528.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11528.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 11528.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 11528.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27564.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11874.77, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALUMINUM SERUM", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.0, "discounted_cash": 25.0, "minimum": 8.66, "maximum": 182.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 39.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.29 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.29 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 155.04 }, { "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 ONION", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN, IGG TOMATO", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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": "Amputation of finger/thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12356.0, "discounted_cash": 3489.0, "minimum": 488.0, "maximum": 9884.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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": 1131.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4778.76 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4778.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "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": 1187.92 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1187.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 681.08, "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": 681.08 }, { "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": 1130.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 5030.27 }, { "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": "AMBULATORY CGM PATIENT EQUIP", "code_information": [ { "code": "95249", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.0, "discounted_cash": 62.0, "minimum": 37.236, "maximum": 171.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 75.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": 62.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 84.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 59.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 88.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 101.9, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 97.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.34 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.34 }, { "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": 65.46 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 64.6, "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": 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": 64.6 }, { "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": 62.34 }, { "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": 139.07, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 61.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ALLERGEN, TILAPIA", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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 TUNA", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 7.0, "minimum": 4.692, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 15.92 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% 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": "ALLERGEN,HORMODENDRUM", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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,ANIMAL, FEATHER MIX", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.0, "discounted_cash": 7.0, "minimum": 4.146, "maximum": 32.69, "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": "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": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "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": 8.51 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 8.1 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "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": 8.21, "additional_payer_notes": "103.00% 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% 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": "AMIKACIN, RANDOM", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.0, "discounted_cash": 15.0, "minimum": 8.53, "maximum": 62.66, "payers_information": [ { "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "ALLERGEN-FORMALDEHYDE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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,HELMENTHOSPORIUM", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 538.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 60.33 }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 7.9866, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 176.71, "10th_percentile": 176.71, "90th_percentile": 447.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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" } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% 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": "AMNIOINFUSION", "code_information": [ { "code": "59070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201.0, "discounted_cash": 324.0, "minimum": 208.974, "maximum": 1201.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 389.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1169.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "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": 341.2, "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": 500.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 438.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 500.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 308.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 454.93, "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": 526.42, "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": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1201.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 503.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 500.32 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 420.72 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "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": 373.69, "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": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 420.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 500.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 357.45, "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": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 341.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.34 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 341.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 487.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 334.7, "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": 341.2, "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": 301.82, "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": 324.95, "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": 301.82 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "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": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 500.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 500.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 718.46, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 406.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 442.86 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 334.7, "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% 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": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5950.0, "minimum": 4254.9918, "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": 7140.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5950.6, "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": 6248.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7027.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6895.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6927.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7329.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 7438.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5653.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8914.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 8330.84, "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": 9639.97, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5950.6, "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": 5733.66 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5950.6, "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": 6010.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9223.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6703.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6703.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6545.66, "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": 5950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6248.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6248.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8925.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6129.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 6248.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4289.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 5950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 5950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 5950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7056.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6129.12, "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": 7537.0, "minimum": 5559.6516, "maximum": 19457.1935, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7537.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8291.4, "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": 7537.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7914.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11306.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7763.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7537.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7537.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7167.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7537.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7537.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 7537.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 7537.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11544.01 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7763.77, "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": 9045.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7537.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7914.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9182.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9009.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9051.65 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9577.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 9422.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7160.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7537.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7537.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11647.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 10552.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12210.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7537.64, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7537.64, "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": 7613.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11683.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10966.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7537.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10966.81 } ] } ] }, { "description": "AMPHETAMINES 5 OR MORE", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.0, "discounted_cash": 114.0, "minimum": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 303.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ALPHA 1 ANTITRYPSIN", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.0, "discounted_cash": 13.0, "minimum": 8.064, "maximum": 168.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 20.5632, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 124.11, "10th_percentile": 124.11, "90th_percentile": 124.11, "count": "1 through 10" }, { "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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 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 Medicare", "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 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 103.59 }, { "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": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 94131.0, "minimum": 76746.3094, "maximum": 160780.93, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 112958.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 94131.9, "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": 98838.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 126750.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 124367.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 124950.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 132202.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 117664.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 89425.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 94131.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 94131.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 160780.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 131784.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 152493.63, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 94131.9, "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": 103416.79 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 94131.9, "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": 95073.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 145904.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 94131.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 94131.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 103545.09, "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": 94131.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 98838.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 98838.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 141197.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 96955.86, "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": 98838.5, "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": 94131.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 94131.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 114068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 94131.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 94131.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 94131.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 94131.9, "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": 96955.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANCHOR CORK SUT AR-1927BCT-475", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18452.0, "minimum": 14532.6202, "maximum": 41624.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22143.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18452.7, "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": 19375.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 24001.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 23550.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 23660.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 25033.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 23065.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17530.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 30445.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 25833.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 29893.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 18452.7, "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": 19582.92 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 18452.7, "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": 18637.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 28601.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39542.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39542.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 20297.97, "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": 18452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19375.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19375.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27679.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19006.28, "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": 19375.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18452.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18452.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20306.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18452.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 18452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 18452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41624.2 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19006.28, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALT, LIVER FIBROSIS", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.0, "discounted_cash": 5.0, "minimum": 3.18, "maximum": 241.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 8.109, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 178.48, "10th_percentile": 178.48, "90th_percentile": 178.48, "count": "1 through 10" }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.51 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.51 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 91.06 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% 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": "ANCHOR DUAL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34122.0, "minimum": 27414.4594, "maximum": 129713.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 40947.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34122.7, "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": 35828.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 45276.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 44425.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 44633.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 47223.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 42653.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 32416.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 34122.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 34122.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 57432.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 47771.75, "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": 55278.74, "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": 34122.7, "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": 36941.39 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 34122.7, "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": 34463.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 52890.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 123227.35 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34122.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 123227.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34122.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 37534.97, "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": 34122.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35828.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 35828.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 51184.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 35146.38, "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": 35828.84, "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": 34122.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34122.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56021.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34122.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 34122.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 34122.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 34122.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 129713.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 35146.38, "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% 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": "ANCHOR JUGGERKNOT 1.5MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9942.0, "minimum": 7536.7572, "maximum": 19627.24, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11931.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10439.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12447.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12213.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12270.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12982.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 12428.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9445.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15789.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 13919.74, "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": 16107.13, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9942.67, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10042.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15411.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18645.88 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18645.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10936.94, "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": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10439.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10439.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14914.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10240.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10439.8, "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": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8356.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 9942.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19627.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10240.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMIKACIN, TROUGH", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.0, "discounted_cash": 15.0, "minimum": 8.53, "maximum": 62.66, "payers_information": [ { "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": "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": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "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": 8.96 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 8.53 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "ALPHA-1-ANTITRYPSIN PHENOTYPE", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 544.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 435.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 22.1238, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 321.5, "10th_percentile": 321.5, "90th_percentile": 321.5, "count": "1 through 10" }, { "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.43, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 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 Medicare", "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 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "ANCHOR MENIS JUGGERSTITCH 2-0", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION OF FINGERTHUMB", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15713.0, "discounted_cash": 3489.0, "minimum": 654.66, "maximum": 12570.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4778.76 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4778.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "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": 1958.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1958.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 654.66, "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": 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": 654.66 }, { "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": 1864.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 5030.27 }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2228.0 }, { "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": 1865.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 15713.0, "discounted_cash": 3489.0, "minimum": 654.66, "maximum": 12570.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2228.0 }, { "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": 1865.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4778.76 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4778.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "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": 1958.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1958.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 654.66, "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": 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": 654.66 }, { "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": 1864.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 5030.27 }, { "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": "AMINO ACID SINGLE QUANT", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.0, "discounted_cash": 16.0, "minimum": 8.41, "maximum": 228.0, "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": "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": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "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": 8.83 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 8.41 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% 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": "ANCHOR PEEK SWIVEL 4.75X19.1MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "Amputation thru metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17651.0, "discounted_cash": 3489.0, "minimum": 662.7, "maximum": 14120.8, "payers_information": [ { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 662.7, "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": 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": 662.7 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health 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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1771.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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" } ] }, { "setting": "outpatient", "gross_charge": 17651.0, "discounted_cash": 3489.0, "minimum": 662.7, "maximum": 14120.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1771.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 662.7, "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": 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": 662.7 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMINO ACIDS PLASMA", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.0, "discounted_cash": 16.0, "minimum": 8.41, "maximum": 228.0, "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": "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": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANCHOR SUTURE JUGGERKNOT 2.9MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "AMYLASE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 6.0, "minimum": 3.8, "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": 7.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 9.9144, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 106.38, "10th_percentile": 106.38, "90th_percentile": 106.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.68 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 121.77 }, { "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": "AMINO ACIDS QNT, URINE", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.0, "discounted_cash": 16.0, "minimum": 8.41, "maximum": 228.0, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANG NSTA EC CAR VER ARC SI LT", "code_information": [ { "code": "36221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6216.0, "discounted_cash": 3367.0, "minimum": 193.18, "maximum": 9045.6, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 193.18, "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": 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": 193.18 }, { "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": 3831.04 }, { "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": 6216.0, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "AMYLASE, 2 HR URINE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 6.0, "minimum": 3.8, "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": 7.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 9.9144, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 106.38, "10th_percentile": 106.38, "90th_percentile": 106.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.68 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.68 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 121.77 }, { "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": "AMITRIPTILINE & NORTRIPTYLINE", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.0, "discounted_cash": 114.0, "minimum": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 INCR CAR WSI BIL", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28295.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 22636.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 324.83, "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": 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": 324.83 }, { "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": 3831.04 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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, RANDOM URINE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 6.0, "minimum": 3.8, "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": 7.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 9.9144, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 106.38, "10th_percentile": 106.38, "90th_percentile": 106.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.68 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.68 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 121.77 }, { "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": "AMIODARONE PANEL", "code_information": [ { "code": "80151", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.0, "discounted_cash": 18.0, "minimum": 8.53, "maximum": 114.4, "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": "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": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "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": 8.96 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 8.53 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "AMMONIUM 24 HOUR URINE", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 201.25, "payers_information": [ { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 201.25 }, { "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" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 191.19 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 191.19 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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" } ] } ] }, { "description": "ANG SCCI IPSI INCR CAR WSI LT", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18834.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 22636.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 324.83, "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": 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": 324.83 }, { "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": 3831.04 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANA, IFA W/RFLX MPLX BEAD", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.0, "discounted_cash": 11.0, "minimum": 6.696, "maximum": 103.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 17.0748, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 60.87, "10th_percentile": 60.87, "90th_percentile": 60.87, "count": "1 through 10" }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 103.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 103.0 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 103.0 }, { "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": "AMMONIA", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 201.25, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 191.19 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 191.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 201.25 }, { "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": "AMPAR1 AB CBA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 168.0, "payers_information": [ { "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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 113.74 }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.4365, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 124.11, "10th_percentile": 124.11, "90th_percentile": 124.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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" } ] } ] }, { "description": "ANG SEC IPSI EX CAR W SI RT", "code_information": [ { "code": "36227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4470.0, "minimum": 118.84, "maximum": 5365.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1169.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4470.0 }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.84, "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": 118.84 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3831.04 } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% 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": "AMPHETAMINE, SERUM", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 416.0, "discounted_cash": 114.0, "minimum": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "AMPHETAMINES, 1 OR 2", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.0, "discounted_cash": 114.0, "minimum": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 303.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 SVA IPSI VERT W SI RT", "code_information": [ { "code": "36226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18995.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 26728.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1771.0 }, { "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": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": 4024.61 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4024.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 360.06, "additional_payer_notes": "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": 360.06 }, { "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": 3831.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANCHOR FIBERTAK AR-3633SP", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "AMPHIPHYSIN AB IFA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 168.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.4365, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 124.11, "10th_percentile": 124.11, "90th_percentile": 124.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 113.74 }, { "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": "AMPHETAMINES, URINE, QUAL", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 114.0, "minimum": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 252.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 135.78 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% 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": "ANCHOR JUGG 2.99MM SHORT DBL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "ANGIO DIALYSIS CIR W/STENT", "code_information": [ { "code": "36903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39716.0, "discounted_cash": 12310.0, "minimum": 293.88, "maximum": 31772.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14772.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3647.0 }, { "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": 9276.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16618.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9276.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11694.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 17234.48, "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": 19942.75, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 19081.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9276.05 }, { "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": 14156.89, "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": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9276.05 }, { "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": 9739.85 }, { "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": 18465.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9739.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 293.88, "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": 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": 293.88 }, { "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": 9271.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9276.05 }, { "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": 27218.16, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15387.93, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12310.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANCHOR SUTURE JUGGERKNOT BL2.9", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "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": 39007.0, "minimum": 25386.553, "maximum": 100795.38, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 46808.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39007.3, "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": 40957.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 51908.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 50932.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 51171.04 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 54141.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 48759.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37056.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 39007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 39007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 65844.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 54610.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 63191.84, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 39007.3, "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": 42352.36 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 39007.3, "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": 39397.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 60461.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 95755.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 95755.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 39007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 42908.03, "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": 39007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40957.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 40957.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 58510.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 40177.52, "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": 40957.67, "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": 39007.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39007.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38433.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 39007.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 39007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 39007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 100795.38 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 40177.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO PULMONARY NON SELECTIVE", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11017.0, "discounted_cash": 3367.0, "minimum": 76.37, "maximum": 8813.6, "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": "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": 1467.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": "fee schedule", "standard_charge_dollar": 769.09 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 92.29 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 165.54 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "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": 1541.35 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1541.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 76.37, "additional_payer_notes": "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": 76.37 }, { "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": 1467.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANG NSTA EC CAR VER ARC SI BI", "code_information": [ { "code": "36221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9367.0, "discounted_cash": 3367.0, "minimum": 193.18, "maximum": 9045.6, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 193.18, "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": 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": 193.18 }, { "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": 3831.04 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% 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" }, { "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" } ] } ] }, { "description": "ANG SCCI IPSI EXCR CAR WSI LT", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7881.0, "discounted_cash": 3367.0, "minimum": 232.0, "maximum": 9438.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": 4024.61 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4024.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 273.95, "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": 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": 273.95 }, { "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": 3831.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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" } ] } ] }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% 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" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANG SCCI IPSI EXCR CAR WSI RT", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7881.0, "discounted_cash": 3367.0, "minimum": 232.0, "maximum": 9438.4, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 273.95, "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": 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": 273.95 }, { "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": 3831.04 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15303.0, "minimum": 11943.7358, "maximum": 38234.14, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18364.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15303.5, "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": 16068.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 19725.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 19354.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19445.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20574.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 19129.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14538.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15303.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15303.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 25021.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 21424.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 24791.65, "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": 15303.5, "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": 16094.36 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15303.5, "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": 15456.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23720.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36322.43 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15303.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36322.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15303.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16833.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15303.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16068.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16068.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22955.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15762.61, "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": 16068.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15303.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15303.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14762.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15303.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15303.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 15303.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 15303.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38234.14 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15762.61, "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": 371.0, "discounted_cash": 92.0, "minimum": 22.48, "maximum": 296.8, "payers_information": [ { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "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": 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": 22.48 }, { "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": 48.7 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 151.41 }, { "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": "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": 48.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.84 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 51.14 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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" } ] } ] }, { "description": "ANG SSI IPSI VERT W SI LT", "code_information": [ { "code": "36225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11018.0, "discounted_cash": 3367.0, "minimum": 232.0, "maximum": 12756.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": 4024.61 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4024.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 321.65, "additional_payer_notes": "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": 321.65 }, { "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": 3831.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22917.0, "minimum": 12329.4664, "maximum": 73855.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 27501.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22917.9, "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": 24063.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 30063.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 29498.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 29636.72 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 31356.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 28647.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21772.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 22917.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 22917.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 38135.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 32085.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 37126.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 22917.9, "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": 24529.21 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 22917.9, "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": 23147.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 35522.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 70162.73 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22917.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 70162.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22917.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 25209.69, "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": 22917.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 24063.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 24063.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 34376.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 23605.44, "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": 24063.8, "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": 22917.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22917.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20239.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22917.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 22917.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 22917.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 22917.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 73855.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 23605.44, "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": 11792.0, "minimum": 9057.2638, "maximum": 39833.67, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14150.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11792.3, "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": 12381.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14958.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14677.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14746.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15601.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 14740.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11202.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11792.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11792.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 18974.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 16509.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 19103.48, "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": 11792.3, "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": 12204.8 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11792.3, "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": 11910.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18278.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37841.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11792.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37841.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11792.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12971.53, "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": 11792.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12381.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12381.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17688.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12146.07, "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": 12381.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13422.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11792.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11792.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 11792.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 11792.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39833.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12146.07, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29891 - ", "code_information": [ { "code": "29891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22054.0, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 17643.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8467.84 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7000.0 }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8467.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "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": 1947.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 640.28, "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": 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": 640.28 }, { "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": 1853.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 8913.52 }, { "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": 22054.0, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 17643.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8467.84 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7000.0 }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8467.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "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": 1947.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 640.28, "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": 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": 640.28 }, { "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": 1853.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 8913.52 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% 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": "AMYLASE, 24 HR URINE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 6.0, "minimum": 3.8, "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": 7.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 9.9144, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 106.38, "10th_percentile": 106.38, "90th_percentile": 106.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.68 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.68 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 121.77 }, { "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": "Ankle arthroscopysurgery - 29897 - ", "code_information": [ { "code": "29897", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18277.0, "discounted_cash": 3489.0, "minimum": 470.42, "maximum": 14621.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8467.84 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7000.0 }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8467.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "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": 1947.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 470.42, "additional_payer_notes": "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": 470.42 }, { "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": 1853.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 8913.52 }, { "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": 18277.0, "discounted_cash": 3489.0, "minimum": 470.42, "maximum": 14621.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8467.84 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7000.0 }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8467.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "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": 1947.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 470.42, "additional_payer_notes": "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": 470.42 }, { "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": 1853.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 8913.52 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% 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": "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": 27865.0, "minimum": 16656.8918, "maximum": 86725.16, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 33438.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27865.4, "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": 29258.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 36781.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 36089.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 36258.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 38363.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 34831.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26472.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 27865.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27865.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 46656.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 39011.57, "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": 45141.96, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 27865.4, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 27865.4, "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": 28144.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 43191.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 82388.9 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27865.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 82388.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27865.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 30651.94, "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": 27865.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29258.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 29258.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 41798.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 28701.36, "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": 29258.67, "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": 27865.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27865.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23845.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27865.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 27865.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 27865.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 27865.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 86725.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 28701.36, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMYLASE, BODY FLUID", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 6.0, "minimum": 3.8, "maximum": 144.0, "payers_information": [ { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 121.77 }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 9.9144, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 106.38, "10th_percentile": 106.38, "90th_percentile": 106.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.68 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.68 }, { "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 Medicare", "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" } ] } ] }, { "description": "ANKLE COMPLETE RIGHT, 3 VIEW", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.0, "discounted_cash": 92.0, "minimum": 26.44, "maximum": 587.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 433.79, "10th_percentile": 433.79, "90th_percentile": 433.79, "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 201.67 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 201.67 }, { "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 Medicare", "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": 26.44, "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": 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": 26.44 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 212.28 }, { "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": "ANGIO DIALYSIS CIRCUIT W/PTA", "code_information": [ { "code": "36902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9004.0, "discounted_cash": 6069.0, "minimum": 221.13, "maximum": 9004.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3647.0 }, { "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": 3194.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8193.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3194.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5765.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 8497.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9004.0, "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": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9004.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3194.96 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3194.96 }, { "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": 3354.71 }, { "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": 9004.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3354.71 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 221.13, "additional_payer_notes": "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": 221.13 }, { "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": 3193.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3194.96 }, { "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": 9004.0, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6069.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10660.0, "discounted_cash": 3489.0, "minimum": 166.65, "maximum": 8528.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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": 1853.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6042.6 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6042.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "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": 1945.97 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1945.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 166.65, "additional_payer_notes": "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": 166.65 }, { "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": 1852.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 6360.63 }, { "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": "ANAEROBIC ID", "code_information": [ { "code": "87076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 8.0, "minimum": 4.848, "maximum": 75.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "120.00% 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": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.67 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 48.07 }, { "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": "ANKLE LEFT W/CONTRAST", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5112.0, "discounted_cash": 835.0, "minimum": 219.61, "maximum": 4089.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1003.13, "additional_payer_notes": "120.00% 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": 835.94, "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": 877.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1128.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 794.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 1170.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1354.22, "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": 835.94, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "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": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1295.71, "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": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "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": 961.33, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 919.53, "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": 927.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 877.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1253.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 861.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "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": 219.61 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "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": 835.94, "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": 352.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1848.26, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "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": 861.02, "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": 548.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 438.4, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 92.53 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 92.53 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 97.4 }, { "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": "ANA, IFA AUTOANTIBODIES", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.0, "discounted_cash": 11.0, "minimum": 6.696, "maximum": 103.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 17.0748, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 60.87, "10th_percentile": 60.87, "90th_percentile": 60.87, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 103.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 103.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 103.0 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% 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": "ANKLE LEFT W/O CONTRAST", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3042.0, "discounted_cash": 254.0, "minimum": 129.73, "maximum": 2433.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 305.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 343.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1596.74 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1596.74 }, { "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": 927.0 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 912.6, "10th_percentile": 912.6, "90th_percentile": 912.6, "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 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 Medicare", "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": 129.73, "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": 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": 129.73 }, { "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": 209.14 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 1680.78 }, { "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": "ANKLE 2 VIEW RIGHT", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 371.0, "discounted_cash": 92.0, "minimum": 22.48, "maximum": 296.8, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.84 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.84 }, { "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 Medicare", "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": 22.48, "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": 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": 22.48 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 151.41 }, { "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": "ANAEROBIC CULTURE", "code_information": [ { "code": "87075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 9.0, "minimum": 5.682, "maximum": 349.6, "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": "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": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 12.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 141.27 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 141.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 7.78 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 7.41 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 148.7 }, { "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": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10941.0, "minimum": 8357.9968, "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": 13129.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10941.7, "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": 11488.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 13803.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 13544.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13607.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14397.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 13677.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10394.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10941.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10941.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 17509.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 15318.31, "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": 17725.47, "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": 10941.7, "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": 11262.53 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10941.7, "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": 11051.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16959.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17725.92 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10941.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17725.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10941.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12035.87, "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": 10941.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11488.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11488.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16412.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11269.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11488.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10941.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10941.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13050.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10941.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10941.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 10941.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 10941.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18658.86 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11269.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANKLE RIGHT W/O CONTRAST", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3042.0, "discounted_cash": 254.0, "minimum": 129.73, "maximum": 2433.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 305.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 343.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1596.74 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1596.74 }, { "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": 927.0 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 912.6, "10th_percentile": 912.6, "90th_percentile": 912.6, "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 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 Medicare", "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": 129.73, "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": 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": 129.73 }, { "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": 209.14 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 1680.78 }, { "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": "ANKLE LEFT W/WO CONTRAST", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6906.0, "discounted_cash": 372.0, "minimum": 258.33, "maximum": 5524.8, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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": "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 Medicare", "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": 258.33, "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": 258.33 }, { "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": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 352.86 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": 42.23, "payers_information": [ { "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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "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": 12.22, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "95.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18607.0, "minimum": 7753.5636, "maximum": 39392.3, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22328.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.3, "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": 19537.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 24211.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 23756.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 23867.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 25252.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 23259.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17676.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18607.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18607.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 30711.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 26050.21, "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": 30143.81, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.3, "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": 19754.17 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.3, "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": 18793.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 28841.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37422.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37422.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 20468.03, "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": 18607.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19537.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19537.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27910.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19165.52, "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": 19537.67, "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": 18607.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25513.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18607.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 18607.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39392.3 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19165.52, "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": 6906.0, "discounted_cash": 372.0, "minimum": 258.33, "maximum": 5524.8, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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": "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 Medicare", "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": 258.33, "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": 258.33 }, { "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": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 352.86 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 LT W/CONTRAST", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3557.0, "discounted_cash": 187.0, "minimum": 103.2, "maximum": 2845.6, "payers_information": [ { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 1571.75 }, { "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" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 224.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 252.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 177.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 261.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1493.16 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1493.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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 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 Medicare", "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": 103.2, "additional_payer_notes": "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": 103.2 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 263.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "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": 42.23, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANCHOR DX FIBERTAK SUTURE ST &", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "ANKLE RT W/CONTRAST", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3557.0, "discounted_cash": 187.0, "minimum": 103.2, "maximum": 2845.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 224.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 252.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 177.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 261.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1493.16 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1493.16 }, { "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 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 Medicare", "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": 103.2, "additional_payer_notes": "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": 103.2 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 263.48 }, { "payer_name": "Traditional 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 1571.75 }, { "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": "ANKLE LT W/WO CONTRAST", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3831.0, "discounted_cash": 187.0, "minimum": 127.29, "maximum": 3610.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 224.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 252.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 177.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 261.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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": "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 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 Medicare", "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": 127.29, "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": 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": 127.29 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 263.48 }, { "payer_name": "Traditional 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "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": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANCHOR BIOABSORABLE 2.5X14.7", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "ANCHOR JUGGERKNOT 2..9MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% 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": "ANKLE RT W/O CONTRAST", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2750.0, "discounted_cash": 111.0, "minimum": 76.76, "maximum": 2200.0, "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": "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1542.71 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1542.71 }, { "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 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 Medicare", "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": 76.76, "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": 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": 76.76 }, { "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": 92.49 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 1623.91 }, { "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": "ANCHOR COMP SWIVL CLSD 4.75", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "ANCHOR SUTURE FIBERTAK AR-3636", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% 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": "ANNA2 (RI) AB IFA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 168.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.4365, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 124.11, "10th_percentile": 124.11, "90th_percentile": 124.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 113.74 }, { "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": "ANCHOR QUATTRO X3 FIBER 5.5MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "ANCHOR, CORKSCREW 5.5X15M SUT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% 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": "Anoscopy and biopsy", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4660.83, "discounted_cash": 1276.0, "minimum": 72.7, "maximum": 4550.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1531.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1169.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "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": 854.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1722.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1212.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 1786.48, "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": 2067.22, "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": 1276.06, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "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": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1977.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.6 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1440.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1467.47, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1440.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1403.67, "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": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 897.33 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1914.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 897.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1314.34, "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": 1339.86, "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": 72.7, "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": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.7 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "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": 854.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2821.37, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1595.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1515.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1314.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANCHOR SUTURE JUGGERKNOT SZ 1", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "ANDROSTENEDIONE", "code_information": [ { "code": "82154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 801.0, "discounted_cash": 28.0, "minimum": 9.28, "maximum": 640.8, "payers_information": [ { "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": "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": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 44.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 9.74 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 9.28 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "ANTERIOR NOSE BLEED-COMPLEX", "code_information": [ { "code": "30903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 594.0, "discounted_cash": 141.0, "minimum": 74.17, "maximum": 594.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 170.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 594.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 191.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CARELON (fka Beacon & Value Options)", "plan_name": "Beacon (fka Value Options) Commercial Non HMO Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 408.0 }, { "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": "case rate", "standard_charge_dollar": 594.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 219.9, "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": 594.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.91 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 348.81 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 348.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.91 }, { "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": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 594.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.26 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 74.17, "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": 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": 74.17 }, { "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": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 146.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.91 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "case rate", "standard_charge_dollar": 367.17 }, { "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": "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% 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" }, { "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" } ] } ] }, { "description": "ANG NSTA EC CAR VER ARC SI", "code_information": [ { "code": "36221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11307.0, "discounted_cash": 3367.0, "minimum": 193.18, "maximum": 9045.6, "payers_information": [ { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": 4024.61 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4024.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 193.18, "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": 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": 193.18 }, { "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": 3831.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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" } ] } ] }, { "description": "ANG SEC IPSI EX CAR W SI LT", "code_information": [ { "code": "36227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4470.0, "minimum": 118.84, "maximum": 5365.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1169.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4470.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": 4024.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4024.61 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.84, "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": 118.84 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3831.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 } ] } ] }, { "description": "ANTERIOR NOSE BLEED-SIMPLE", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 353.0, "discounted_cash": 141.0, "minimum": 52.67, "maximum": 353.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 170.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 353.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 191.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CARELON (fka Beacon & Value Options)", "plan_name": "Beacon (fka Value Options) Commercial Non HMO Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 353.0 }, { "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": "case rate", "standard_charge_dollar": 353.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 219.9, "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": 353.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.91 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.91 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.26 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 52.67, "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": 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": 52.67 }, { "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": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 146.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.91 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% 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": "ANG NSTA EC CAR VER ARC SI RT", "code_information": [ { "code": "36221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6216.0, "discounted_cash": 3367.0, "minimum": 193.18, "maximum": 9045.6, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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": "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 Medicare", "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": 193.18, "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": 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": 193.18 }, { "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": 3831.04 }, { "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": 6216.0, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANG SSI IPSI VERT W SI BIL", "code_information": [ { "code": "36225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15945.0, "discounted_cash": 3367.0, "minimum": 232.0, "maximum": 12756.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 321.65, "additional_payer_notes": "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": 321.65 }, { "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": 3831.04 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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-MULLERIAN HORMONE", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.0, "discounted_cash": 17.0, "minimum": 8.41, "maximum": 174.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 127.52 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 127.52 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 130.0 }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 26.4231, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 65.01, "10th_percentile": 65.01, "90th_percentile": 65.01, "count": "1 through 10" } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% 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": "ANG SCCI IPSI EXCR CAR SSI BIL", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11798.0, "discounted_cash": 3367.0, "minimum": 232.0, "maximum": 9438.4, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 273.95, "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": 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": 273.95 }, { "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": 3831.04 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6227.0, "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": 7472.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6538.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7402.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7297.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7721.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 7783.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5915.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9390.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 8718.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10087.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6227.15, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6289.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9652.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9150.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9150.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6849.87, "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": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6538.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6538.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9340.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6413.96, "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": 6538.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 6227.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9631.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6413.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-NUCLEAR ANTIBODY SCREEN", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.0, "discounted_cash": 12.0, "minimum": 7.254, "maximum": 165.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.4977, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 122.34, "10th_percentile": 122.34, "90th_percentile": 122.34, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.16 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 121.22 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% 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": "ANG SCCI IPSI INCR CAR WSI RT", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18834.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 22636.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": 4024.61 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4024.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 324.83, "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": 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": 324.83 }, { "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": 3831.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% 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-THROMB 3 AG", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.0, "discounted_cash": 10.0, "minimum": 3.11, "maximum": 57.6, "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": "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": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 3.27 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 3.11 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANTI-CYCLIC CITRULLINE PEP AB", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 386.0, "discounted_cash": 12.0, "minimum": 7.77, "maximum": 308.8, "payers_information": [ { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.8135, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 228.13, "10th_percentile": 228.13, "90th_percentile": 228.13, "count": "1 through 10" }, { "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 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 Medicare", "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 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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "ANG SIC IPSI INCRAN CAR WSI BI", "code_information": [ { "code": "36224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15736.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 13119.5876, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1771.0 }, { "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": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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": 4024.61 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4024.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 363.37, "additional_payer_notes": "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": 363.37 }, { "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": 3831.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANGIO DIALYSIS CIRCUIT", "code_information": [ { "code": "36901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1591.0, "discounted_cash": 1678.0, "minimum": 155.09, "maximum": 1591.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1169.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "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": 1591.0, "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": 1467.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "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": 1591.0, "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": 1591.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1591.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "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": 1591.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "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": 1591.0, "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": 1591.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "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": 1591.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1541.35 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1541.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "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": 1591.0, "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": 155.09, "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": 1591.0, "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": 155.09 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "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": 1591.0, "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": 1467.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 1591.0, "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": 1591.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY;HERPES SIMPLEX,TYPE 2", "code_information": [ { "code": "86696", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.0, "discounted_cash": 19.0, "minimum": 8.1, "maximum": 121.6, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 26.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 29.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.2 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.2 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 90.74 }, { "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": "ANTI-HU TITER", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 152.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.4365, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 96.92, "10th_percentile": 96.92, "90th_percentile": 96.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.3 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 127.68 }, { "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 SVA IPSI VERT W SI BIL", "code_information": [ { "code": "36226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33410.0, "discounted_cash": 5933.0, "minimum": 232.0, "maximum": 26728.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1771.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 360.06, "additional_payer_notes": "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": 360.06 }, { "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": 3831.04 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANGIO SELECTIVE ADD VESSEL", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3101.0, "minimum": 46.57, "maximum": 3101.0, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3101.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3101.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3101.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1042.53 }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1042.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3101.0 }, { "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": 3101.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3101.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.57, "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": 46.57 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3101.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3101.0 }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1097.4 } ] } ] }, { "description": "ANTIBODY;HERPES SIMPLEX,TYPE I", "code_information": [ { "code": "86695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 13.0, "minimum": 7.914, "maximum": 86.83, "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": "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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 82.49 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 82.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 86.83 }, { "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": "ANTI-STRIATED MUSCLE AB", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 168.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 113.74 }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.4365, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 124.11, "10th_percentile": 124.11, "90th_percentile": 124.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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" } ] } ] }, { "description": "ANGIO EXIST CATH/RECHECK", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 831.0, "discounted_cash": 3367.0, "minimum": 51.05, "maximum": 831.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "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": 831.0, "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": 831.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 831.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "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": 831.0, "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": 831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "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": 831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 831.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 831.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "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": 831.0, "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": 831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 831.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 831.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "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": 831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 831.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 831.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "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": 831.0, "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": 152.6, "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": 831.0, "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": 152.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "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": 831.0, "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": 831.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 831.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 129.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 831.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 831.0, "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": 734.0, "discounted_cash": 92.0, "minimum": 26.44, "maximum": 587.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 433.79, "10th_percentile": 433.79, "90th_percentile": 433.79, "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": 48.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 125.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 143.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 201.67 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 201.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 51.14 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 26.44, "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": 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": 26.44 }, { "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": 48.7 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 212.28 }, { "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": "ANTIBODY;HIV-2", "code_information": [ { "code": "86702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.0, "discounted_cash": 13.0, "minimum": 8.1, "maximum": 84.8, "payers_information": [ { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.55, "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": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.87, "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": 19.6 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "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": 14.2, "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": 13.52, "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": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "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": 13.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "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": 21.9, "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": 13.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY IDENTIFICATION", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.0, "discounted_cash": 382.0, "minimum": 37.0, "maximum": 275.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "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": 275.0, "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": 113.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "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": 275.0, "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": 275.0, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "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": 275.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 184.06 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "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": 275.0, "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": 275.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 184.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "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": 275.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.66 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "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": 275.0, "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": 275.0, "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": 275.0, "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": 37.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "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": 275.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 122.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 275.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 275.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGIOTENSION CONVERTING ENZYME", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 438.4, "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": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 92.53 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 92.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 97.4 }, { "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": "ANKLE RIGHT W/CONTRAST", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5112.0, "discounted_cash": 835.0, "minimum": 219.61, "maximum": 4089.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1003.13, "additional_payer_notes": "120.00% 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": 835.94, "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": 877.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1128.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 794.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 1170.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1354.22, "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": 835.94, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "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": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1295.71, "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": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "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": 961.33, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 919.53, "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": 927.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 877.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1253.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 861.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "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": 219.61 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "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": 835.94, "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": 352.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1848.26, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1044.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 835.94, "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": 861.02, "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": 33581.0, "minimum": 6661.31, "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": 40297.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33581.2, "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": 35260.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 44541.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 43703.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 43908.72 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 46457.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41976.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31902.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 56499.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 47013.74, "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": 54401.61, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33581.2, "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": 36341.61 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33581.2, "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": 33917.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 52050.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36939.32, "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": 33581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35260.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 35260.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 50371.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 34588.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 35260.26, "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": 33581.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33581.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6661.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33581.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 33581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 33581.2, "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": 34588.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY;ENCEPHALITIS,ST LOUIS", "code_information": [ { "code": "86653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.0, "discounted_cash": 13.0, "minimum": 7.914, "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": 15.83, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "Ankle arthroscopy/surgery", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25892.0, "discounted_cash": 3489.0, "minimum": 529.58, "maximum": 20713.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8467.84 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7000.0 }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8467.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "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": 1947.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 529.58, "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": 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": 529.58 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1853.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 8913.52 }, { "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": "ANNA1 (HU) AB IFA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 168.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.4365, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 124.11, "10th_percentile": 124.11, "90th_percentile": 124.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 113.74 }, { "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": "AORTOGRAM ABDOMINAL", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5641.0, "discounted_cash": 3367.0, "minimum": 54.5, "maximum": 5641.0, "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": "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": 1467.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1746.19 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1746.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "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": 1541.35 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1541.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 54.5, "additional_payer_notes": "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": 54.5 }, { "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": 1467.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "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": 5641.0, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 1838.09 }, { "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;ENCEPHALITS,EAST EQUI", "code_information": [ { "code": "86652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.0, "discounted_cash": 13.0, "minimum": 7.914, "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": 15.83, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "ANKLE LT W/O CONTRAST", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2750.0, "discounted_cash": 111.0, "minimum": 76.76, "maximum": 2200.0, "payers_information": [ { "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": 76.76 }, { "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": 92.49 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 1623.91 }, { "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": "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1542.71 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1542.71 }, { "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 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 Medicare", "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": 76.76, "additional_payer_notes": "100.00% of Medicare 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% 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": "APLIGRAF WOUND PREP-WC", "code_information": [ { "code": "15002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2530.0, "discounted_cash": 788.0, "minimum": 204.38, "maximum": 2024.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 945.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1063.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 748.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 1103.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1276.75, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1221.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1555.88 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1555.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 866.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 924.72 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1182.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 924.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.38 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 880.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1742.53, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 985.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1637.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "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": 11.484, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANKLE RT W/WO CONTRAST", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3831.0, "discounted_cash": 187.0, "minimum": 127.29, "maximum": 3610.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 224.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 252.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 177.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 261.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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": "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 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 Medicare", "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": 127.29, "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": 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": 127.29 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 263.48 }, { "payer_name": "Traditional 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "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": 192.65, "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": "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" }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APP MULTILAYER COMPRESSION RT", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 451.0, "discounted_cash": 173.0, "minimum": 22.97, "maximum": 451.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 207.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 233.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 164.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 242.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.71, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 451.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 259.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "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": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 383.12, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.48, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIDIURETIC HORMONE", "code_information": [ { "code": "84588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.0, "discounted_cash": 33.0, "minimum": 20.364, "maximum": 124.0, "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": "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": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 45.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 32.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.0 }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 52.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 25.83 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 24.6 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANNA3 AB IFA", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 168.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.4365, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 124.11, "10th_percentile": 124.11, "90th_percentile": 124.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.05 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 113.74 }, { "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": "ANTERIOR COLPORRHAPHY, REPAIR CYSTOCELE", "code_information": [ { "code": "57240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8515.5, "discounted_cash": 5334.0, "minimum": 561.2, "maximum": 8515.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6401.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2836.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "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": 5601.16, "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": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7201.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 7468.22, "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": 8515.5, "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": 5334.44, "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", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "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": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8433.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "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": 6134.61, "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": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8433.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5867.88, "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": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8001.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "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": 5601.16, "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": 561.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "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": 561.2 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "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": 5334.44, "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": 2483.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8515.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6668.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8515.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 8515.5, "discounted_cash": 5334.0, "minimum": 561.2, "maximum": 8515.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6401.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2836.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "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": 5601.16, "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": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7201.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 7468.22, "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": 8515.5, "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": 5334.44, "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", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "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": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8433.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "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": 6134.61, "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": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8433.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5867.88, "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": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8001.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "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": 5601.16, "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": 561.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "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": 561.2 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "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": 5334.44, "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": 2483.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8515.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6668.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8515.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% 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": "ANTI-HU WESTERN BLOT", "code_information": [ { "code": "84181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.0, "discounted_cash": 17.0, "minimum": 8.1, "maximum": 60.0, "payers_information": [ { "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "Appl unipln uni ext fixj sys", "code_information": [ { "code": "20690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25017.0, "discounted_cash": 7737.0, "minimum": 488.0, "maximum": 20013.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9285.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1630.0 }, { "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": 2007.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10446.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 10832.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12535.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7433.96 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7433.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "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": 2107.88 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11606.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2107.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 560.72, "additional_payer_notes": "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": 560.72 }, { "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": 2006.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "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": 17108.25, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 7825.22 }, { "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": "APHERESIS PLTS-BACT LEUK REDUC", "code_information": [ { "code": "P9073", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2307.0, "discounted_cash": 604.0, "minimum": 239.51, "maximum": 1891.74, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 816.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 640.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% 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": "ANTI-NEUTROPHIL CYTO AB, IGG", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 11.0, "minimum": 6.918, "maximum": 201.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 17.6409, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 148.93, "10th_percentile": 148.93, "90th_percentile": 446.8, "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.42 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.42 }, { "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" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 85.71 }, { "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": "APOLIPOPROTEIN B", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.0, "discounted_cash": 21.0, "minimum": 8.41, "maximum": 54.0, "payers_information": [ { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 54.0 }, { "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 54.0 }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.0 }, { "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 Medicare", "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" } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% 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": "ANTI-STREPTOLYSIS O, QUANT", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.0, "discounted_cash": 7.0, "minimum": 4.38, "maximum": 144.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.73 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 119.72 }, { "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": "ARSENIC URINE", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.0, "discounted_cash": 18.0, "minimum": 8.66, "maximum": 199.2, "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": "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": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 25.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 9.09 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 8.66 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "APP MULTILAYER COMPRESSION LT", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 451.0, "discounted_cash": 173.0, "minimum": 22.97, "maximum": 451.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 207.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 233.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 164.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 242.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.71, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 451.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 259.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "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": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 383.12, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.48, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-MUSK AB TITER,QNT", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 18.0, "minimum": 8.41, "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": 22.08, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 135.0 }, { "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": "ANTI-THROMBIN III ACTIVITY", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.0, "discounted_cash": 11.0, "minimum": 3.11, "maximum": 299.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 212.0 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 212.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 212.0 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% 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": "ANTIBODY SCREEN", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "discounted_cash": 55.0, "minimum": 3.11, "maximum": 122.8653, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 66.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 14.9481, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 85.7, "10th_percentile": 85.7, "90th_percentile": 85.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 75.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 40.86 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 49.3, "10th_percentile": 49.3, "90th_percentile": 49.3, "count": "1 through 10" }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 86.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 84.98 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 84.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 89.45 }, { "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": "ANTIBODY;HIV-1", "code_information": [ { "code": "86701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.0, "discounted_cash": 8.0, "minimum": 5.334, "maximum": 93.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.4, "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": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.78 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 9.93 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.7 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "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": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 84.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "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": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 84.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "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": 12.89 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "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": 9.33, "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": 8.89, "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": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 88.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL LINE PLACEMENT - 36620 - 36100600", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 927.0, "minimum": 41.79, "maximum": 927.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 927.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 927.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 622.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 622.63 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.79, "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": 41.79 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 592.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% 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": "ANTIBODY TITER", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 181.0, "minimum": 3.11, "maximum": 140.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "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": 140.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "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": 140.0, "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": 140.0, "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "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": 140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "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": 140.0, "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": 140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "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": 140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "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": 140.0, "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": 140.0, "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": 140.0, "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": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "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": 140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "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": 140.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY;LYMPHO CHORIOMENGITIS", "code_information": [ { "code": "86727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.0, "discounted_cash": 12.0, "minimum": 7.722, "maximum": 248.0, "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": "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 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 Medicare", "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 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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ARTERIAL LINE PLACEMENT - 36620 - 48060055", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 884.0, "minimum": 41.79, "maximum": 927.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 884.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 884.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.79, "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": 41.79 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 592.68 } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% 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": "ANTIBODY;ENCEPHALITIS WEST EQU", "code_information": [ { "code": "86654", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.0, "discounted_cash": 13.0, "minimum": 7.914, "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": 15.83, "additional_payer_notes": "120.00% 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "ANTIGEN ID CHARGE", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.0, "discounted_cash": 382.0, "minimum": 3.11, "maximum": 272.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "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": 272.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "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": 272.0, "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": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "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": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "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": 272.0, "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": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "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": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "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": 272.0, "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": 272.0, "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": 272.0, "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": 272.0, "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": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 272.0, "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": 272.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Arthr si jt opn b1grf instrm", "code_information": [ { "code": "27280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22820.0, "discounted_cash": 18697.0, "minimum": 1359.72, "maximum": 22820.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22436.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2846.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22820.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17762.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 22820.0, "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": 22820.0, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22820.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21502.11, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20567.24, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10657.26 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22820.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10657.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19258.41, "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": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1359.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1359.72 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "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": 10144.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22820.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22820.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "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": 19258.41, "additional_payer_notes": "103.00% of Medicare 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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% 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": "ANTIBODY;ENCEPHALITIS,CALIFORN", "code_information": [ { "code": "86651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.0, "discounted_cash": 13.0, "minimum": 7.914, "maximum": 64.0, "payers_information": [ { "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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "95.00% of Medicare Rates" } ] } ] }, { "description": "ANTIGEN IDENTIFICATION", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.0, "discounted_cash": 382.0, "minimum": 3.11, "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": 245.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "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": 245.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "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": 245.0, "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": 245.0, "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": 9.14 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "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": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "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": 245.0, "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": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "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": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "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": 245.0, "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": 245.0, "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": 245.0, "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": 245.0, "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": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 33.21 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Arthrd si jt perqmin nvas", "code_information": [ { "code": "27279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24445.0, "discounted_cash": 18697.0, "minimum": 783.8, "maximum": 24445.0, "payers_information": [ { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10657.26 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24445.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10657.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19258.41, "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": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 783.8, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 783.8 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "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": 10144.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24445.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23371.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "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": 19258.41, "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": 22436.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2836.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24445.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17762.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 24445.0, "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": 24445.0, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 24445.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21502.11, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20567.24, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 24445.0, "discounted_cash": 18697.0, "minimum": 783.8, "maximum": 24445.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22436.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2836.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24445.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17762.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 24445.0, "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": 24445.0, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 24445.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21502.11, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20567.24, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10657.26 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24445.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10657.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19258.41, "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": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 783.8, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 783.8 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "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": 10144.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24445.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23371.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "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": 19258.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9666.0, "minimum": 7310.0542, "maximum": 16337.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11600.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.9, "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": 10150.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12072.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11845.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11901.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12592.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 12083.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9183.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9666.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9666.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15314.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 13533.66, "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": 15660.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.9, "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": 9850.41 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.9, "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": 9763.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14983.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10633.59, "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": 9666.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10150.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10150.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14500.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9956.91, "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": 10150.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9666.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16337.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9666.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 9666.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 9666.9, "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": 9956.91, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENTESIS SM JNT LEFT", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 886.0, "discounted_cash": 327.0, "minimum": 32.26, "maximum": 1330.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 886.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 441.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 886.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 668.97 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 668.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 360.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 224.15 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 224.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 32.26, "additional_payer_notes": "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": 32.26 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 213.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 723.7, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 704.18 }, { "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": "Application of long arm cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3650.5, "discounted_cash": 298.0, "minimum": 65.02, "maximum": 3650.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 357.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 313.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 402.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 283.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 417.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 483.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3650.5 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 462.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 673.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 673.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 328.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 313.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 447.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.02 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 155.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 659.43, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 372.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 709.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.2, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 3650.5, "discounted_cash": 298.0, "minimum": 65.02, "maximum": 3650.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 357.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 313.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 402.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 283.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 417.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 483.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3650.5 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 462.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 673.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 673.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 328.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 313.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 447.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.02 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 155.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 659.43, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 372.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 709.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.2, "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": 103.0, "discounted_cash": 11.0, "minimum": 6.696, "maximum": 103.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 17.0748, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 60.87, "10th_percentile": 60.87, "90th_percentile": 60.87, "count": "1 through 10" }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 103.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health 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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 103.0 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 103.0 }, { "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 ELBOW LEFT", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 903.0, "discounted_cash": 372.0, "minimum": 65.17, "maximum": 822.5362, "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": "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": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 689.49 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 82.74 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 116.87 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 107.76 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 65.17, "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": 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": 65.17 }, { "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": 102.63 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ANTITHROMBIN, ENZYMATIC", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 374.0, "discounted_cash": 11.0, "minimum": 3.11, "maximum": 299.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 241.38 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 241.38 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 254.08 }, { "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": "ANTINUCLEAR ANTIGEN ABS X10", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 376.0, "discounted_cash": 17.0, "minimum": 8.1, "maximum": 300.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.56 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.56 }, { "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 103.75 }, { "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": "ARTHROGRAM WRIST LEFT", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1148.0, "discounted_cash": 372.0, "minimum": 97.19, "maximum": 999.03, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 97.19, "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": 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": 97.19 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ARTERIAL BLOOD GASES", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 281.0, "discounted_cash": 78.0, "minimum": 37.0, "maximum": 281.0, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 207.49 }, { "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" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 94.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 106.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 281.0 }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 122.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.89 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 197.12 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 197.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 86.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.28 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.52, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54203.0, "minimum": 14654.1, "maximum": 92015.68, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 65044.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 54203.4, "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": 56913.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 72540.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 71175.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 71509.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 75660.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 67754.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51493.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 54203.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 54203.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 92015.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 75884.8, "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": 87809.56, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 54203.4, "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": 59185.91 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 54203.4, "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": 54745.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 84015.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 54203.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 54203.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 59623.74, "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": 54203.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 56913.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 56913.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 81305.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 55829.5, "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": 56913.57, "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": 54203.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54203.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14654.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 54203.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 54203.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 54203.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 54203.4, "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": 55829.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AORTA", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1397.0, "discounted_cash": 111.0, "minimum": 31.02, "maximum": 1117.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 133.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 172.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 973.56 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 973.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "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": 99.52 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 31.02, "additional_payer_notes": "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": 31.02 }, { "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": 94.78 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 1024.8 }, { "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": "ARTHROGRAM WRIST RIGHT", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1148.0, "discounted_cash": 372.0, "minimum": 97.19, "maximum": 999.03, "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": "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": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 107.76 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 97.19, "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": 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": 97.19 }, { "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": 102.63 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ARTHROCENTESIS SM JNT BILAT", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1330.0, "discounted_cash": 327.0, "minimum": 32.26, "maximum": 1330.0, "payers_information": [ { "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 Medicare", "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": 32.26, "additional_payer_notes": "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": 32.26 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 213.37 }, { "payer_name": "Traditional 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": 723.7, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 704.18 }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1169.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 441.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 1330.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 668.97 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 668.97 }, { "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" } ] } ] }, { "description": "APHASIA ASSESSMENT/EA HR", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 441.0, "discounted_cash": 94.0, "minimum": 76.734, "maximum": 441.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 113.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 99.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 441.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 128.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 441.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 90.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 132.87, "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": 153.75, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.91 }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 147.11, "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": 161.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 441.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.15, "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": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 441.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 104.4, "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": 149.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 99.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 441.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 441.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.91 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "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": 441.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 441.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.4, "additional_payer_notes": "A Indicator - 110.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 94.91, "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": 97.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AORTOGRAM ABD & BIL LOW EXT", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5712.0, "discounted_cash": 3367.0, "minimum": 59.29, "maximum": 5712.0, "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": "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": 1467.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3398.65 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3398.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "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": 1541.35 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1541.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 59.29, "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": 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": 59.29 }, { "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": 1467.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1467.95 }, { "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": 5712.0, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 3577.53 }, { "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": "ARTHROCENTESIS SM JNT RIGHT", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 886.0, "discounted_cash": 327.0, "minimum": 32.26, "maximum": 1330.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 886.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 441.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 886.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 668.97 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 668.97 }, { "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 Medicare", "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": 32.26, "additional_payer_notes": "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": 32.26 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 213.37 }, { "payer_name": "Traditional 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": 723.7, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 704.18 }, { "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": "APOLIPOPROTEIN A1", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.0, "discounted_cash": 21.0, "minimum": 8.41, "maximum": 54.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "120.00% 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": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 54.0 }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.0 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 54.0 }, { "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": "AORTOGRAM THORAC W/SER", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4413.0, "discounted_cash": 5933.0, "minimum": 63.25, "maximum": 4413.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "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": 4413.0, "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": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "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": 4413.0, "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": 4413.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "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": 4413.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "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": 4413.0, "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": 4413.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "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": 4413.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4024.61 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4024.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "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": 4413.0, "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": 63.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "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": 63.25 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "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": 4413.0, "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": 3831.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3832.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 4413.0, "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": 4413.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHRODESIS, EACH ADDITIONAL SPACE", "code_information": [ { "code": "22585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9360.96, "minimum": 313.15, "maximum": 9360.96, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9360.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9360.96 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9360.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9360.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9360.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9360.96 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 313.15, "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": 313.15 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 9360.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9360.96 } ] } ] }, { "description": "APP BODY INJTR TIMED SUBQ INJ", "code_information": [ { "code": "96377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.0, "discounted_cash": 49.0, "minimum": 18.09, "maximum": 164.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 164.0 }, { "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": 40.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 67.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 47.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 77.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17 }, { "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": 42.18 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 18.09, "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": 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": 18.09 }, { "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": 40.17 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "APERFIXII CANN TIBIAL 9X30M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 18.0, "median_amount": 3504.87, "10th_percentile": 3504.87, "90th_percentile": 3504.87, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9823.55, "10th_percentile": 9823.55, "90th_percentile": 9823.55, "count": "1 through 10" } ] } ] }, { "description": "ARTHROGRAM ANKLE RIGHT", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 903.0, "discounted_cash": 372.0, "minimum": 95.97, "maximum": 903.0, "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": "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": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 903.0 }, { "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": 129.66 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 107.76 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 95.97, "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": 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": 95.97 }, { "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": 102.63 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% 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": "APHER PLTS-BACT IRR LEUK REDUC", "code_information": [ { "code": "P9073", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2307.0, "discounted_cash": 604.0, "minimum": 239.51, "maximum": 1891.74, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 816.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 239.51 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 640.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ASPIRATION REN CYST BY NDL", "code_information": [ { "code": "50390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3629.0, "discounted_cash": 755.0, "minimum": 83.91, "maximum": 3629.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 906.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1169.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "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": 792.88, "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": 349.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1019.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 349.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 717.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 1057.17, "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": 1223.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3629.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "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": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1170.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 349.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1815.9 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "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": 868.39, "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": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1815.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 349.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 830.63, "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": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 367.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1132.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 367.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "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": 792.88, "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": 83.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "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": 83.91 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "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": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 349.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 349.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1669.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 943.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1911.47 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM ELBOW RIGHT", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 903.0, "discounted_cash": 372.0, "minimum": 65.17, "maximum": 822.5362, "payers_information": [ { "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": 689.49 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 82.74 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 116.87 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 65.17, "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": 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": 65.17 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" }, { "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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" } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% 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": "APP MULTILAYER COMPRESSION BIL", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 451.0, "discounted_cash": 173.0, "minimum": 22.97, "maximum": 451.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 207.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 233.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 164.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 242.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.71, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 451.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 259.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "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": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 383.12, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.48, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY NONENDOCRINE RECPTOR", "code_information": [ { "code": "84238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.0, "discounted_cash": 36.0, "minimum": 19.8, "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": 43.88, "additional_payer_notes": "120.00% 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": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 49.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 34.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 51.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.0 }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 20.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 19.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.88, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "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": 37.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROGRAM HIP RIGHT", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1399.0, "discounted_cash": 372.0, "minimum": 95.97, "maximum": 1119.2, "payers_information": [ { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.97 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" }, { "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 95.97, "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": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12532.0, "minimum": 9665.8496, "maximum": 25399.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15039.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12532.6, "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": 13159.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 15963.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 15663.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 15736.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16650.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 15665.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11905.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12532.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12532.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 20249.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 17545.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 20302.78, "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": 12532.6, "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": 13024.88 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 12532.6, "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": 12657.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 19425.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12532.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12532.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13785.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12532.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13159.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13159.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18798.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12908.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13159.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12532.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12532.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25399.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12532.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12532.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 12532.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 12532.6, "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": 12908.58, "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% 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": "ASSAY OF PROTEIN URINE - 84156 - 30119215", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.0, "discounted_cash": 3.0, "minimum": 2.202, "maximum": 92.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 5.6151, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 67.97, "10th_percentile": 67.97, "90th_percentile": 67.97, "count": "1 through 10" }, { "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": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 82.5 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 82.5 }, { "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 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 Medicare", "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 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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 86.84 }, { "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": "ARTHROGRAM KNEE RIGHT", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1256.0, "discounted_cash": 372.0, "minimum": 78.28, "maximum": 1004.8, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 741.59 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 88.99 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 148.52 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 78.28, "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": 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": 78.28 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19378.0, "minimum": 15293.8314, "maximum": 32040.06, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23254.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19378.7, "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": 20347.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 25258.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 24783.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 24899.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26345.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 24223.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18409.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19378.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19378.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 32040.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 27130.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 31393.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 19378.7, "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": 20608.67 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 19378.7, "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": 19572.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 30036.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19378.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19378.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 21316.57, "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": 19378.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20347.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20347.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29068.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19960.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 20347.64, "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": 19378.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19378.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28246.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19378.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19378.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 19378.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 19378.7, "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": 19960.06, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AST (SGOT)", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 221.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 77.48 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 77.48 }, { "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 Medicare", "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" }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 81.56 }, { "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": "ARTHROGRAM SHOULDER RIGHT", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1560.0, "discounted_cash": 372.0, "minimum": 98.72, "maximum": 1248.0, "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": "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": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 617.26 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 617.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 107.76 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 98.72, "additional_payer_notes": "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": 98.72 }, { "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": 102.63 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 649.75 }, { "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": "APPL MLTPLN UNI EXT FIXJ SYS", "code_information": [ { "code": "20692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15188.99, "discounted_cash": 13690.0, "minimum": 558.0, "maximum": 15188.99, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15188.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1771.0 }, { "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": 2007.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15188.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13006.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 15188.99, "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": 15188.99, "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": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 15188.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7433.96 }, { "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": 15188.99, "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": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7433.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "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": 2107.88 }, { "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": 15188.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2107.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 1065.72, "additional_payer_notes": "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": 1065.72 }, { "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": 2006.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "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": 15188.99, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15188.99, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 7825.22 }, { "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" } ] }, { "setting": "outpatient", "gross_charge": 15189.0, "discounted_cash": 13690.0, "minimum": 558.0, "maximum": 15188.99, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15188.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1771.0 }, { "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": 2007.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15188.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13006.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 15188.99, "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": 15188.99, "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": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 15188.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7433.96 }, { "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": 15188.99, "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": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7433.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "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": 2107.88 }, { "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": 15188.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2107.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 1065.72, "additional_payer_notes": "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": 1065.72 }, { "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": 2006.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "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": 15188.99, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15188.99, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 7825.22 }, { "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% 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": "APT FETAL HEMOGLOBIN", "code_information": [ { "code": "83033", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.0, "discounted_cash": 8.0, "minimum": 3.8, "maximum": 138.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "120.00% 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": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "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": 3.99 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 3.8 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6004.0, "minimum": 4299.0552, "maximum": 20111.9354, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7205.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6004.2, "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": 6304.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7100.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6966.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6999.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7405.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 7505.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5703.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6004.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6004.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9006.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 8405.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 9726.8, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6004.2, "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": 5793.04 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6004.2, "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": 6064.24, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9306.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17296.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6004.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17296.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6004.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6604.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6004.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6304.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6304.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9006.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6184.33, "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": 6304.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6004.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6004.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5059.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6004.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6004.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 6004.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 6004.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18207.03 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6184.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ASP BREAST CYST EA ADD", "code_information": [ { "code": "19001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 503.0, "minimum": 18.74, "maximum": 503.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 503.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 503.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "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": 18.74 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 503.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.0 } ] } ] }, { "description": "ARSENIC, BLOOD", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 249.0, "discounted_cash": 18.0, "minimum": 8.66, "maximum": 199.2, "payers_information": [ { "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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 25.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "95.00% of Medicare Rates" } ] } ] }, { "description": "ASPERGILLUS AB. CF", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 15.0, "minimum": 8.1, "maximum": 84.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 62.0 }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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 : 4", "code_information": [ { "code": "0084", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 107437.19, "maximum": 112809.05, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 112809.05, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ASPERGILLUS ANTIGEN", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 278.0, "discounted_cash": 11.0, "minimum": 7.188, "maximum": 222.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ARM ANKLE INDEX", "code_information": [ { "code": "93922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1774.0, "discounted_cash": 141.0, "minimum": 65.69, "maximum": 1419.2, "payers_information": [ { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.52 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 65.69, "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": 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": 65.69 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health 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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1048.43, "10th_percentile": 1048.43, "90th_percentile": 1048.43, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 191.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 655.7 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 177.04 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 132.7 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 219.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.78 }, { "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": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 532.2, "10th_percentile": 532.2, "90th_percentile": 532.2, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Av fusion direct any site", "code_information": [ { "code": "36821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20869.0, "discounted_cash": 3367.0, "minimum": 558.0, "maximum": 16695.2, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1771.0 }, { "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": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11164.21 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11164.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "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": "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": 3203.79 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 646.36, "additional_payer_notes": "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": 646.36 }, { "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": 3049.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "case rate", "standard_charge_dollar": 11751.8 }, { "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": "Aspirate pleura w/ imaging", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5926.0, "discounted_cash": 668.0, "minimum": 96.89, "maximum": 4740.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 802.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1169.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "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": 702.38, "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": 863.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 903.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 863.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 635.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 936.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1083.67, "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": 668.93, "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", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "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": 668.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1036.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 863.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "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": 769.27, "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": 668.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 863.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 735.82, "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": 668.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 702.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 907.14 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1003.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 907.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 689.0, "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": 702.38, "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": 96.89, "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": 668.93, "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": 96.89 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "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": 668.93, "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": 863.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 863.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1479.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 836.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 668.93, "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": 689.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Artery-vein nonautograft", "code_information": [ { "code": "36830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13775.0, "discounted_cash": 5933.0, "minimum": 653.62, "maximum": 13119.5876, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2228.0 }, { "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": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11164.21 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11164.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "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": "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": 3203.79 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 653.62, "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": 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": 653.62 }, { "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": 3049.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "case rate", "standard_charge_dollar": 11751.8 }, { "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" } ] }, { "setting": "outpatient", "gross_charge": 13775.0, "discounted_cash": 5933.0, "minimum": 653.62, "maximum": 13119.5876, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2228.0 }, { "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": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11164.21 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11164.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "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": "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": 3203.79 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 653.62, "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": 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": 653.62 }, { "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": 3049.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "case rate", "standard_charge_dollar": 11751.8 }, { "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": "AV NODE ABLATION", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11371.0, "discounted_cash": 8317.0, "minimum": 232.0, "maximum": 11371.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10088.0 }, { "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": 11371.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 11228.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11371.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7901.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 11371.0, "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": 11371.0, "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": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11371.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11371.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11371.0 }, { "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": 11371.0 }, { "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": 11371.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11371.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 533.79, "additional_payer_notes": "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": 533.79 }, { "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": 11371.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11371.0 }, { "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": 11371.0, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ASPIRATION BREAST CYST", "code_information": [ { "code": "19000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1062.0, "discounted_cash": 755.0, "minimum": 38.01, "maximum": 1062.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 906.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1062.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "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": 792.88, "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": 592.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1019.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 717.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 1057.17, "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": 1062.0, "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": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1062.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "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": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1062.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.17 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 611.98 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "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": 868.39, "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": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 611.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 830.63, "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": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 621.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1062.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 621.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "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": 792.88, "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": 38.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "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": 38.01 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "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": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 591.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1062.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 943.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 644.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENT LARGE JT", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1155.0, "discounted_cash": 327.0, "minimum": 41.35, "maximum": 5280.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1155.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 441.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 458.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CARELON (fka Beacon & Value Options)", "plan_name": "Beacon (fka Value Options) Commercial Non HMO Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 408.0 }, { "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": 1155.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "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": 953.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 668.97 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 668.97 }, { "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 Medicare", "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": 41.35, "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": 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": 41.35 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 213.37 }, { "payer_name": "Traditional 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": 723.7, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 704.18 }, { "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": "ASSAY NEPHELOMETRY NOT SPEC", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 13.0, "minimum": 8.1, "maximum": 123.17, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "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": 22.03, "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": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 31.65 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "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": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.01 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "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": 15.64, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.72 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "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": 14.28, "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": 13.6, "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": 13.6, "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": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "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": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 123.17 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROCENTESIS MED JNT", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 930.0, "discounted_cash": 327.0, "minimum": 32.93, "maximum": 930.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 930.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 441.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 458.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CARELON (fka Beacon & Value Options)", "plan_name": "Beacon (fka Value Options) Commercial Non HMO Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 408.0 }, { "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": 930.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "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": 930.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 668.97 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 668.97 }, { "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 Medicare", "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": 32.93, "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": 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": 32.93 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 213.37 }, { "payer_name": "Traditional 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": 723.7, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 704.18 }, { "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": "ARSENIC UR FRACT", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.0, "discounted_cash": 18.0, "minimum": 8.66, "maximum": 199.2, "payers_information": [ { "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 Medicare", "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 25.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 } ] } ] }, { "description": "ASSAY OF TRIGLYCERIDES", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 5.0, "minimum": 3.444, "maximum": 120.67, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 114.64 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 114.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 120.67 }, { "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" } ] } ] }, { "description": "Arthrodesis subtalar", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25892.0, "discounted_cash": 13690.0, "minimum": 690.0, "maximum": 25892.0, "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2228.0 }, { "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": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18482.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13006.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt 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": "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21220.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12086.23 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12086.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 4898.0 }, { "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": 4961.83 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 737.66, "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": 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": 737.66 }, { "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": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 25892.0, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 12722.35 }, { "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": "ARTERIAL LINE INSERTION", "code_information": [ { "code": "36140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 835.0, "minimum": 85.0, "maximum": 879.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 835.0 }, { "payer_name": "CARELON (fka Beacon & Value Options)", "plan_name": "Beacon (fka Value Options) Commercial Non HMO Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 408.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 835.0 }, { "payer_name": "Community Partners Health plan", "plan_name": "Community Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 835.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.0, "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": 85.0 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 592.68 } ] } ] }, { "description": "B PERTUSSIS AB IgA (IMMBLOT)", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 13.0, "minimum": 7.914, "maximum": 68.8, "payers_information": [ { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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" } ] } ] }, { "description": "AST, LIVER FIBROSIS", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 221.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 77.48 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 77.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "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": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 81.56 }, { "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": "ARTHROGRAM ANKLE LEFT", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 903.0, "discounted_cash": 372.0, "minimum": 95.97, "maximum": 903.0, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 903.0 }, { "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": 129.66 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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": 95.97, "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": 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": 95.97 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ARTHOCENTESIS ASP/INJ SM JNT", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 886.0, "discounted_cash": 327.0, "minimum": 32.26, "maximum": 1330.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 886.0 }, { "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 441.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 458.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CARELON (fka Beacon & Value Options)", "plan_name": "Beacon (fka Value Options) Commercial Non HMO Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 408.0 }, { "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": 886.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "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": 886.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 668.97 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 668.97 }, { "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 Medicare", "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": 32.26, "additional_payer_notes": "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": 32.26 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 213.37 }, { "payer_name": "Traditional 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": 723.7, "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 704.18 }, { "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": "B PERTUSSIS AB IgG (IMMBLOT)", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 13.0, "minimum": 7.914, "maximum": 68.8, "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": "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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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" } ] } ] }, { "description": "ARTHROGRAM HIP LEFT", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1399.0, "discounted_cash": 372.0, "minimum": 95.97, "maximum": 1119.2, "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": "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": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 107.76 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 95.97, "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": 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": 95.97 }, { "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": 102.63 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "Arthrd si jt prq wo tfxj dev", "code_information": [ { "code": "27278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23115.0, "discounted_cash": 18697.0, "minimum": 441.72, "maximum": 23115.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22436.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2836.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14434.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 23115.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14434.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17762.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 23115.0, "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": 23115.0, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 23115.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14434.35 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21502.11, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14434.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20567.24, "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": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15156.07 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23115.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15156.07 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19258.41, "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": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 441.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 441.72 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "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": 14427.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14434.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23115.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23115.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "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": 19258.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "B-HYDROXYBUTYRATE", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 8.0, "minimum": 3.8, "maximum": 75.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "120.00% 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": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.3 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 3.99 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 57.16 }, { "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": "ARTHROGRAM TMJ LEFT", "code_information": [ { "code": "70332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1396.0, "discounted_cash": 254.0, "minimum": 50.23, "maximum": 1116.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 305.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 343.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 530.12 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 63.61 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 85.2 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 394.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 232.0 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 50.23, "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": 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": 50.23 }, { "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": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ARTHROGRAM KNEE LEFT", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1256.0, "discounted_cash": 372.0, "minimum": 78.28, "maximum": 1004.8, "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": "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": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 741.59 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 88.99 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 148.52 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 107.76 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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": 78.28, "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": 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": 78.28 }, { "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": 102.63 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "B.PERTUSSIS CULTURE", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.0, "discounted_cash": 6.0, "minimum": 3.978, "maximum": 128.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.98, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 97.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 97.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.61 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.96, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 102.14 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTO DEGLY PACKED CELLS", "code_information": [ { "code": "P9039", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1498.0, "discounted_cash": 311.0, "minimum": 108.61, "maximum": 1248.86, "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": "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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 420.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 482.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.61 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.61 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.04 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "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 Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.61 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 1162.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "Arthrp ntrcrp/crp/mtcr ntrps", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31056.0, "discounted_cash": 3489.0, "minimum": 751.43, "maximum": 24844.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2836.0 }, { "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": 2936.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9895.52 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9895.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "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": 5150.0 }, { "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": 3083.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3083.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 751.43, "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": 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": 751.43 }, { "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": 2935.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 10416.34 }, { "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": "ARTHROGRAM SHOULDER LEFT", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1560.0, "discounted_cash": 372.0, "minimum": 98.72, "maximum": 1248.0, "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": "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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 502.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 576.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 617.26 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 617.26 }, { "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 Medicare", "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": 98.72, "additional_payer_notes": "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": 98.72 }, { "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 VA", "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 649.75 }, { "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": "BABESIA MICROTI IGG", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.0, "discounted_cash": 12.0, "minimum": 7.434, "maximum": 67.2, "payers_information": [ { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.76 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 13.98 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.62 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "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": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "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": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "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": 17.97 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "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": 12.39, "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": 12.39, "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": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.87, "additional_payer_notes": "Laboratory - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "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": 12.76, "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": 14.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "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": 20.07, "additional_payer_notes": "162.00% of Medicare Rates" } ] } ] }, { "description": "AUTO PROCESSING CHARGE", "code_information": [ { "code": "86890", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 433.0, "discounted_cash": 181.0, "minimum": 70.59, "maximum": 433.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 281.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 221.26 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 221.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.15 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 73.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 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 VA", "methodology": "fee schedule", "standard_charge_dollar": 70.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 232.91 }, { "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": "ARTHRT ELBW CAPSL EXC RLS", "code_information": [ { "code": "24006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18509.33, "discounted_cash": 3489.0, "minimum": 676.05, "maximum": 14807.464, "payers_information": [ { "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": 1547.03 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1547.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 676.05, "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": 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": 676.05 }, { "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": 1472.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 7825.22 }, { "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": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2228.0 }, { "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": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7433.96 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7433.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "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 } ] }, { "setting": "outpatient", "gross_charge": 18509.3, "discounted_cash": 3489.0, "minimum": 676.05, "maximum": 14807.464, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2228.0 }, { "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": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7433.96 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7433.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "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": 1547.03 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1547.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "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": 676.05, "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": 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": 676.05 }, { "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": 1472.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": 7825.22 }, { "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": "ARTHROGRAM TMJ RIGHT", "code_information": [ { "code": "70332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1396.0, "discounted_cash": 254.0, "minimum": 50.23, "maximum": 1116.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 305.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 343.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 530.12 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "fee schedule", "standard_charge_dollar": 63.61 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "fee schedule", "standard_charge_dollar": 85.2 }, { "payer_name": "Cigna Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 394.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "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": "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": 232.0 }, { "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 Medicare", "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": 50.23, "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": 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": 50.23 }, { "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": "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% 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": "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "additional_payer_notes": "100% 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": "ASAOP - IOP SESSION-4HR-906", "code_information": [ { "code": "G0410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 749.0, "minimum": 32.886, "maximum": 749.0, "payers_information": [ { "payer_name": "CARELON (fka Beacon & Value Options)", "plan_name": "Beacon (fka Value Options) Commercial Non HMO Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 255.0 }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "fee schedule", "standard_charge_dollar": 749.0 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 204.16 }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 99.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Value Options", "plan_name": "Value Options Commercial Non-HMO Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 255.0 } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18937.0, "maximum": 38550.6415, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20944.64 }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20944.64 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18937.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22046.99 } ] } ] }, { "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": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% 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": "ASPERGILLIS, (HYPER PNEUM)", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 15.0, "minimum": 8.1, "maximum": 84.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 62.0 }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20810.0, "minimum": 16470.7712, "maximum": 43126.14, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 24972.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20810.3, "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": 21850.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 27202.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 26690.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 26816.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 28372.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 26012.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19769.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 20810.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20810.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 34505.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "case rate", "standard_charge_dollar": 29134.49, "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": 33712.77, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 20810.3, "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": 22194.61 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 20810.3, "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": 21018.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 32256.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40969.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20810.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40969.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20810.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 22891.33, "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": 20810.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21850.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 31215.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21434.61, "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": 21850.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20810.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20810.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24736.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20810.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 20810.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "case rate", "standard_charge_dollar": 20810.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "case rate", "standard_charge_dollar": 20810.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43126.14 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21434.61, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AVULSION NAIL PLATE (SINGLE)", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.0, "discounted_cash": 213.0, "minimum": 49.22, "maximum": 4021.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 256.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 310.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 224.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 288.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 203.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 299.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 310.0, "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": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 310.0 }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 310.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.04, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 235.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 224.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 310.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.22, "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": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.22 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 310.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 267.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ASPERGILLUS ANTIBODY", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 15.0, "minimum": 8.1, "maximum": 84.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% 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 Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare 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 Smart Healt 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": 62.0 }, { "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "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": "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 Medicare", "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 VA", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "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": "ASAOP-CONTINUING CARE-1.5HR915", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.0, "discounted_cash": 108.0, "minimum": 8.178, "maximum": 749.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "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": 47.0, "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": 47.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "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": 47.0, "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": 47.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Health Spring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "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": 47.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "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": 47.0, "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": 47.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HealthLink, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "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": 47.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "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": 47.0, "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": 24.43, "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": 47.0, "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": 24.43 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "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": 47.0, "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": 47.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 25.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Village MD Chicago", "plan_name": "Village MD Chicago Medicare Advantage HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.0, "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": 47.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL IDENTIFICATION", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.0, "discounted_cash": 8.0, "minimum": 4.848, "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": 9.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 12.3624, "standard_charge_algorithm": "Not To Exceed $4026", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 81.56, "10th_percentile": 81.56, "90th_percentile": 81.56, "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": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "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 Smart Healt Care", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "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 Health Spring", "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 System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 69.0 }, { "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": "HealthLink, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 69.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 87.3, "10th_percentile": 20.7, "90th_percentile": 161.4, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois M